Document Detail


Clinical features and prognostic factors in childhood pneumococcal meningitis.
MedLine Citation:
PMID:  18327426     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Despite progress in antibiotic therapy and intensive care, childhood pneumococcal meningitis remains a devastating disease, with morbidity and mortality rates among the highest of any cause of bacterial meningitis. We conducted this study to find the factors associated with disease outcome in clinical settings. METHODS: All pediatric medical charts during the period from January 1984 to December 2003 with the diagnosis of pneumococcal meningitis were reviewed. We recorded patients' symptoms and signs, laboratory data and treatments. Outcome and neurological complications were also analyzed. RESULTS: In total, 40 episodes of pneumococcal meningitis from 37 patients aged 3 months to 10 years were identified. Predisposing factors were found in 13 patients (35.1%), and included recent history of head injury, immunocompromised states and cranial base anomaly. All patients had fever during illness. Patients older than 24 months of age tended to complain of nuchal rigidity (19/21, 90.5%) and those younger than 6 months of age tended to present irritability (6/7, 85.7%). The overall mortality rate was 25% (10 out of 40 episodes). The following variables were associated with mortality after statistical analysis: consciousness disturbance, shock, endotracheal tube intubation and hyponatremia (sodium <130 mEq/L) at admission (p=0.001, p<0.001, p<0.001, and p=0.012, respectively). Also, laboratory findings of less than 20/mm3 white cell count in cerebrospinal fluid (CSF), lower CSF glucose level and CSF-to-blood glucose ratio were significantly higher in non-survivors (p=0.003, p=0.009, p=0.027). Variables associated with morbidity were seizure attack and focal neurological sign occurring hospitalization (p=0.017, p=0.017). CONCLUSIONS: The mortality of childhood pneumococcal meningitis remains high. If a child with pneumococcal meningitis presents with consciousness disturbance, hypotension, endotracheal intubation or hyponatremia at admission, the disease mortality rate increases. CSF findings with low white cell count, low glucose level and CSF-to-blood glucose ratio are also warning signs of a bad outcome. Seizure attack and focal neurological sign are the factors associated with further neurological sequelae.
Authors:
Yen-Nan Chao; Nan-Chang Chiu; Fu-Yuan Huang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi     Volume:  41     ISSN:  1684-1182     ISO Abbreviation:  J Microbiol Immunol Infect     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-03-10     Completed Date:  2008-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100956211     Medline TA:  J Microbiol Immunol Infect     Country:  China    
Other Details:
Languages:  eng     Pagination:  48-53     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Cerebrospinal Fluid / chemistry
Child
Child, Preschool
Female
Glucose / cerebrospinal fluid
Humans
Infant
Infant, Newborn
Male
Meningitis, Pneumococcal / complications,  diagnosis*,  mortality,  therapy
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome
Chemical
Reg. No./Substance:
50-99-7/Glucose

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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