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

Öz

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.

Anahtar Kelimeler

• Bacterial meningitis, children, signs and symptoms, sequelae

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

Öz

Kaynakça

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