Clinical Characteristics and Prognostic Factors in Childhood Bacterial Meningitis: A Multicenter Study

Year 2013, , 80 - 84, 01.01.2013

Özden Türel Canan Yıldırım Yüksel Yılmaz Ferda Akdaş Sezer Külekçi Mustafa Bakır

https://doi.org/10.5152/balkanmedj.2012.092

Abstract

Objective: To evaluate clinical features and sequela in children with acute bacterial meningitis (ABM). Study Design: Multicenter retrospective study. Material and Methods: Study includes retrospective chart review of children hospitalised with ABM at 11 hospitals in İstanbul during 2005. Follow up visits were conducted for neurologic examination, hearing evaluation and neurodevelopmental tests. Results: Two hundred and eighty three children were included in the study. Median age was 12 months and 68.6% of patients were male. Almost all patients had fever at presentation (97%). Patients younger than 6 months tended to present with feeding difficulties (84%), while patients older than 24 months were more likely to present with vomitting (93%) and meningeal signs (84%). Seizures were present in 65 (23%) patients. 26% of patients were determined to have at least one major sequela. The most common sequelae were speech or language problems (14.5%). 6 patients were severely disabled because of meningitis. Presence of focal neurologic signs at presentation and turbid cerebrospinal fluid appearance increased sequelae significantly. Childen under 24 months of age developed neurologic sequelae more commonly than older children. Conclusion: Symptoms and signs were largely depending on the age of the patient. Speech or language problems were the most common sequelae following meningitis. Turkish Başlık: Çocukluk çağı bakteriyel menenjitlerinin klinik özellikleri ve prognostik faktörler: Çok merkezli çalışma Anahtar Kelimeler: Bakteriyel menenjit, çocuklar, belirti ve bulgular, sekeller Amaç: Akut bakteriyel menenjit (ABM)' li çocuklarda klinik özelliklerin ve sekellerin araştırılması amaçlandı. Gereç ve Yöntemler: 2005 yılında, İstanbul'da 11 hastanede akut bakteriyel menenjit sebebiyle yatarak tedavi gören çocukların dosyaları geriye dönük olarak incelendi. Çalışmaya alınan hastalar çağrılarak nörolojik muayeneleri yapıldı; işitmeleri değerlendirildi ve nörogelişimsel testler uygulandı. Bulgular: Çalışmaya alınan 283 hastanın yaş ortancası 12 aydı ve % 68,6' sı erkekti. Başvuruda olguların hemen hepsinde (%97) ateş mevcuttu. Altı aydan küçük çocuklar daha çok beslenme güçlüğü (%84) ile gelirken, 2 yaşından büyüklerde başvuruda kusma (%93) ve meningeal irritasyon bulguları (%84) varlığı daha sıktı. Konvülsiyon, 65 olguda (%23) mevcuttu. Hastaların %26'sında en az bir önemli sekel gelişimi tespit edildi. En sık görülen sekel, konuşma ve dil problemleri (%14,5) idi. Altı hastada menenjite bağlı ağır nörolojik sekel gelişti. Başlangıçta fokal nörolojik bulgu varlığı ve bulanık BOS görünümü sekel gelişimini belirgin olarak arttıran faktörler olarak bulundu. 2 yaş altı çocuklarda nörolojik sekel gelişiminin büyük çocuklara oranla daha fazla olduğu saptandı. Sonuç: Belirti ve bulgular büyük oranda hastanın yaşı ile ilişkili bulundu. En sık gözlenen sekel konuşma ve dil problemleri olarak tespit edildi.

Keywords

Bacterial meningitis, children, signs and symptoms, sequelae

Clinical Characteristics and Prognostic Factors in Childhood Bacterial Meningitis: A Multicenter Study

Abstract

References

• Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998200 N Engl J Med 2011;364:2016-25. [CrossRef]
• Feigin RD, Pearlman E. Bacterial meningitis beyond the neonatal period. In: Feigin RD, Demler GJ, Cherry JD, Kaplan SL, editors. Textbook of pediatric infectious diseases. 5th ed. Philadelphia: Saunders; 2004:443-74.
• Chandran A, Herbert H, Misurski D, Santosham M. Long-term sequelae of childhood bacterial meningitis:an underappreciated problem. Pediatr Infect Dis J 2011;30:3-6. [CrossRef]
• World Health Organization (WHO). WHO report of the technical review group meeting, Global program for vaccines and Immunizations. Vaccine research and Development. Geneva, Switzerland: WHO;1998.
• Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II:a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics 1992;89:91-7.
• Scheld WM. Bacterial meningitis in the patient at risk:intrinsic risk factors and host defense mechanisms. Am J Med 1984;76:193-207. [CrossRef] Somer A, Yalçın I, Salman N, Ones U, Guler N, Kaygusuz A. Pneumococcal meningitis in children:Evaluation of 46 cases. Flora 1999;4:107-13.
• Aygun AD, Sen CEN, Aydınoglu AH, Yılmaz E, Tutunculer F, Akarsu A, et al. [Childhood meningitis in a regional medical center in Elazığ]. Çocuk Sağlığı ve Hastalıkları Derg 2001;44:141-8.
• Feigin RD, McCracken GH Jr, Klein JO. Diagnosis and management of meningitis. Pediatr Infect Dis J 1992;11:785-814. [CrossRef]
• Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T. Clinical features suggestive of meningitis in children:a systematic review of prospective data. Pediatrics 2010;12:952-60. [CrossRef]
• Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849-59. [CrossRef]
• Levy M, Wong E, Fried D. Diseases that mimic meningitis. Analysis of 650 lumbar punctures. Clin Pediatr (Phila) 1990;29:254-61. [CrossRef]
• Kaplan SL. Clinical presentations, diagnosis and prognostic factors of bacterial meningitis. Infect Dis Clin North Am 1999;3:579-94. [CrossRef] Arditi M, Mason EO Jr, Bradley JS, Tan TQ, Barson WJ, Schutze GE, et al. Three year multicenter surveillance of pneumococcal meningitis in children. Clinical characteristics and outcome related to penicillin susceptibility and dexamethasone use. Pediatrics 1998;102:1087-97. [CrossRef]
• Green SM, Rothrock SG, Clem KJ, Zurcher RF, Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics 1993;92:527-34.
• Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children:a meta-analysis. Pediatr Infect Dis J 1993;12:389-94. [CrossRef]
• Grimwood K, Anderson VA, Bond L, Catroppa C, Hore RL, Keir EH, et al. Adverse outcomes of bacterial meningitis in school-age survivors. Pediatrics 1995;95:646-56.
• Kirimi E, Tuncer O, Arslan S, Ataş B, Caksen H, Uner A, et al. Prognostic factors in children with purulent meningitis in Turkey. Acta Med Okayama 2003;57:39-44.
• Koomen I, Grobbee DE, Roord JJ, Donders R, Jennekens-Schinkel A, van Furth AM. Hearing loss at school age in survivors of bacterial meningitis:assessment, incidence, and prediction. Pediatrics 2003;112:1049-53. [CrossRef]
• Anderson V, Bond L, Catroppa C, Grimwood K, Keir E, Nolan T. Childhood bacterial meningitis:impact of age at illness and acute medical complications on long term outcome. J Int Neuropsychol Soc 1997;3:147-58.
• Kilpi T, Anttila M, Kallio MJ, Peltola H. Severity of childhood bacterial meningitis and duration of illness before diagnosis. Lancet 1991;338:406-9. [CrossRef]
• Feldman WE. Concentrations of bacteria in cerebrospinal fluid of patients with bacterial meningitis. J Pediatr 1976;88:549-52. [CrossRef]
• Lebel MH, McCracken GH. Delayed cerebrospinal fluid sterilization and adverse outcome of bacterial meningitis in infants and children. Pediatrics 1989;83:161-7.
• Chavez-Bueno S, McCracken G. Bacterial meningitis in children. Pediatr Clin N Am 2005;52:795-810. [CrossRef]
• Fortnum HM. Hearing impairment after bacterial meningitis:A review. Arch Dis Child 1992;67:1228-33. [CrossRef]
• Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD. Seizures and other neurologic sequelae of bacterial meningitis in children. N Engl J Med 1990;323:1651-7. [CrossRef]
• Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2010;8:CD004405.
• Peltola H, Roine I, Fernández J, González Mata A, Zavala I, Gonzalez Ayala S, et al. Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol. Pediatrics 2010;125:e1-8. [CrossRef]