Predictors of acute bacterial meningitis in children from a malaria-endemic area of Papua New Guinea.
Predictors of acute bacterial meningitis (ABM) were assessed in 554 children in Papua New Guinea 0.2-10 years of age who were hospitalized with culture-proven meningitis, probable meningitis, or non-meningitic illness investigated by lumbar puncture. Forty-seven (8.5%) had proven meningitis and 36 (6.5%) had probable meningitis. Neck stiffness, Kernig's and Brudzinski's signs and, in children < 18 months of age, a bulging fontanel had positive likelihood ratios (LRs) ≥ 4.3 for proven/probable ABM. Multiple seizures and deep coma were less predictive (LR = 1.5-2.1). Single seizures and malaria parasitemia had low LRs (≤ 0.5). In logistic regression including clinical variables, Kernig's sign and deep coma were positively associated with ABM, and a single seizure was negatively associated (P ≤ 0.01). In models including microscopy, neck stiffness and deep coma were positively associated with ABM and parasitemia was negatively associated with ABM (P ≤ 0.04). In young children, a bulging fontanel added to the model (P < 0.001). Simple clinical features predict ABM in children in Papua New Guinea but malaria microscopy augments diagnostic precision.
Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea. drlaman@yahoo.com
Moses
M
Laman
Laurens
L
Manning
Andrew R
AR
Greenhill
Trevor
T
Mare
Audrey
A
Michael
Silas
S
Shem
John
J
Vince
William
W
Lagani
Ilomo
I
Hwaiwhanje
Peter M
PM
Siba
Ivo
I
Mueller
Timothy M E
TM
Davis
D000208:Acute Disease; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000150:complications; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009127:Muscle Rigidity / Q000150:complications; D010219:Papua New Guinea / Q000453:epidemiology; D018512:Parasitemia / Q000150:complications / Q000175:diagnosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012640:Seizures / Q000150:complications; D013129:Spinal Puncture / Q000379:methods