title: Bacterial meningitis in children <2 years of age in a tertiary care hospital in South India: an assessment of clinical and laboratory features.
abstract: OBJECTIVE
  To assess the clinical and laboratory features of suspected meningitis to assist in the accurate diagnosis of bacterial meningitis in young Indian children.
  
  
  METHODS
  Children <2 years of age with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected, and cases were classified based on cerebrospinal fluid findings as clinical, aseptic, or probable and confirmed bacterial meningitis.
  
  
  RESULTS
  A total of 2564 children with suspected meningitis were enrolled over 45 months; 156 cases of aseptic and 51 cases of bacterial meningitis were identified. Stiff neck and bulging fontanelle were more common in bacterial meningitis (P < .05), but were present in <15% of patients. The World Health Organization and American Academy of Pediatrics classifications for high suspicion of bacterial meningitis were met in 84% and 88% of cases of bacterial meningitis, respectively, but were also present in 54% and 74% cases of aseptic meningitis. Culture and gram stain were positive in 7 (14%) and 4 (8%) cases of bacterial meningitis.
  
  
  CONCLUSIONS
  Signs of bacterial meningitis and proposed criteria for high suspicion of bacterial meningitis are non-specific in this population. Standard microbiological tests for bacteria are insensitive in this setting, necessitating highly sensitive methods to identify bacterial meningitis.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Sean Patrick
authors.initials: SP
authors.lastname: Fitzwater
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramachandran
authors.forename: Krishnamoorthy
authors.initials: K
authors.lastname: Nedunchelian
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Kahn
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Aruna
authors.initials: A
authors.lastname: Chandran
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000382:microbiology; D062606:Tertiary Care Centers; D063128:Tertiary Health Care