Pediatric Infectious Disease

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VOLUME 3 , ISSUE 4 ( October-December, 2021 ) > List of Articles

Original Article

Clinical Profile, Cerebrospinal Fluid Findings, and Outcome of Acute Meningitis in Children: A Recent Audit from a Tertiary Center in India

Kabbur Anusha Raj, Yellanthoor Ramesh Bhat, Shrikiran Aroor

Keywords : Bacteria, Cerebrospinal fluid, Children, Infants, Meningitis

Citation Information : Raj KA, Bhat YR, Aroor S. Clinical Profile, Cerebrospinal Fluid Findings, and Outcome of Acute Meningitis in Children: A Recent Audit from a Tertiary Center in India. Pediatr Inf Dis 2021; 3 (4):135-139.

DOI: 10.5005/jp-journals-10081-1319

License: CC BY-NC 4.0

Published Online: 27-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objective: Periodic surveillance of causative organisms of acute meningitis in children is helpful. Cerebrospinal fluid (CSF) findings characterize the type of meningitis and guide therapy to improve the outcome. We aimed to analyze clinical features, CSF characteristics, causative organisms, and the outcome of meningitis in children. Materials and methods: Children aged from 1 month to 18 years admitted to a teaching hospital with a provisional diagnosis of meningitis were studied retrospectively. Clinical data, CSF analysis, and complications of meningitis were retrieved from medical records. Meningitis was further classified depending on laboratory findings into acute bacterial meningitis (ABM), probable bacterial meningitis (APBM), and aseptic meningitis (ASM). Results: Among 50 children with meningitis, 9 (18%) had ABM, 34 (68%) had APBM, and 7 (14%) had ASM. The causative bacteria included Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterobacter cloacae, Streptococcus viridians, Brucella, and Salmonella typhimurium. Important clinical features included fever (96%), seizures (50%), headache (44%), vomiting (70%), altered sensorium (56%), neck stiffness (56%), cranial nerve palsy (16%), and focal neurological deficits (10%). The median CSF WBC levels in ABM, APBM, and ASM groups were 310, 125, and 140 cells/mm3, respectively. The mean CSF glucose and protein levels in the same groups, respectively, were 29.5 ± 23.1, 51.2 ± 23.8, and 51.7 ± 8.7 mg/dL; and 441.5 ± 546.9, 99.1 ± 79.1, and 100.1 ± 82.6 mg/dL. Complications among 43 bacterial meningitis included hydrocephalus (8, 18.6%), hearing loss (4, 9.3%), visual impairment (3, 6.9%), brain abscess (3, 6.9%), subdural effusion (1, 2.3%), and infarct (1, 2.3%). Conclusion: The present study has explored the causative bacteria in acute meningitis in children. Furthermore, the study explored the characteristics of CSF and identified the important complications.

  1. Fitzwater SP, Ramachandran P, Nedunchelian K, et al. Bacterial meningitis in children <2 years of age in a tertiary care hospital in South India: an assessment of clinical and laboratory features. J Pediatr 2013;163(1 Suppl):S32–S37. DOI: 10.1016/j.jpeds.2013.03.028.
  2. Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA 2007;297(1):52. DOI: 10.1001/jama.297.1.52.
  3. Dubos F, Lamotte B, Bibi-Triki F, et al. Clinical decision rules to distinguish between bacterial and aseptic meningitis. Arch Dis Child 2006;91(8):647–650. DOI: 10.1136/adc.2005.085704.
  4. Prasad R, Kapoor R, Srivastava R, et al. Cerebrospinal fluid TNF-α, IL-6, and IL-8 in children with bacterial meningitis. Pediatric Neurol 2014;50(1):60–65. DOI: 10.1016/j.pediatrneurol.2013.08.016.
  5. Garg A, Sharma A, Kumari S, et al. Clinical profile and outcome of pediatric bacterial meningitis: a prospective study from tertiary institute in Northern India. Int J Res Med Sci 2018;6(8):2739–2745. DOI: 10.18203/2320-6012.ijrms20183261.
  6. Karanika M, Vasilopoulou VA, Katsioulis AT, et al. Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the meningitis registry. PLoS ONE 2009;4(7):e6426. DOI: 10.1371/journal.pone.0006426.
  7. Curtis S, Stobart K, Vandermeer B, et al. Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics 2010;126(5):952–960. DOI: 10.1542/peds.2010-0277.
  8. Chinchankar N, Mane M, Bhave S, et al. Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatr 2002;39(10):914–921.
  9. Jayaraman Y, Veeraraghavan B, Chethrapilly Purushothaman GK, et al. Burden of bacterial meningitis in India: preliminary data from a hospital based sentinel surveillance network. PLoS ONE 2018;13(5):e0197198. DOI: 10.1371/journal.pone.0197198.
  10. Janowski AB, Hunstad DA. Acute bacterial meningitis beyond neonatal period. In: Kliegman RM, et al., ed. Nelson textbook of paediatrics. 21st ed., Philadelphia: Elsevier; 2019. pp. 12526–12554.
  11. Berkhout B. Infectious diseases of the nervous system: pathogenesis and worldwide impact. IDrugs 2008;11(11):791–795.
  12. Sáez-Llorens X, McCracken GH. Bacterial meningitis in children. Lancet 2003;361(9375):2139–2148. DOI: 10.1016/S0140-6736(03) 13693-8.
  13. Swanson D. Meningitis. Pediatr Rev 2015;36(12):514–524. DOI: 10.1542/pir.36-12-514.
  14. Feigin RD, Pearlman E. Bacterial meningitis beyond the neonatal period. In: Feigin RD, Demler GJ, Cherry JD, et al., ed. Textbook of pediatric infectious diseases. 8th ed., Philadelphia: Saunders; 2019. pp. 443–474.
  15. Shameem S, Vinod Kumar CS, Neelagund YF. Bacterial meningitis: rapid diagnosis and microbial profile: a multicentered study. J Commun Dis 2008;40(2):111–120.
  16. Singhi SC, Mohankumar D, Singhi PD, et al. Evaluation of polymerase chain reaction (PCR) for diagnosing haemophilus influenzae b meningitis. Ann Trop Paediatr 2002;22(4):347–353. DOI: 10.1179/027249302125002010.
  17. Das BK, Gurubacharya RL, Mohapatra TM, et al. Bacterial antigen detection test in meningitis. Indian J Pediatr 2003;70(10):799–801. DOI: 10.1007/BF02723800.
  18. Kennedy WA, Chang SJ, Purdy K, et al. Incidence of bacterial meningitis in Asia using enhanced CSF testing: polymerase chain reaction, latex agglutination and culture. Epidemiol Infect 2007;135(7):1217–1226. DOI: 10.1017/S0950268806007734.
  19. Harrison LH, Trotter CL, Ramsay ME. Global epidemiology of meningococcal disease. Vaccine 2009;27(Suppl 2):B51–B63. DOI: 10.1016/j.vaccine.2009.04.063.
  20. Türel O, Yıldırım C, Yılmaz Y, et al. Clinical characteristics and prognostic factors in childhood bacterial meningitis: a multicenter study. Balkan Med J 2013;30(1):80–84. DOI: 10.5152/balkanmedj. 2012.092.
  21. Nigrovic LE, Malley R, Macias CG, et al. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics 2008;122(4):726–730. DOI: 10.1542/peds.2007-3275.
  22. Rashmi K. Aseptic meningitis: diagnosis and treatment. Indian J Pediatr 2005;72(1):57–63. DOI: 10.1007/BF02760582.
  23. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39(9):1267–1284. DOI: 10.1086/425368.
  24. Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of bacterial versus aseptic meningitis in childhood. Ann Emerg Med 1992;21(8):910–914. DOI: 10.1016/s0196-0644(05)82926-9.
  25. Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis 2010;10(1):32–42. DOI: 10.1016/S1473-3099(09) 70306-8.
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