Clinical profile and outcome of children with acute bacterial meningitis in a tertiary care centre in eastern Nepal
PDF

Keywords

Cerebrospinal fluid
Coma
Complications
Intracranial pressure
Seizures

How to Cite

Bhatta, M., Kafle, S. P., Rai, B. ., & Subedi, R. (2021). Clinical profile and outcome of children with acute bacterial meningitis in a tertiary care centre in eastern Nepal. Journal of Kathmandu Medical College, 10(2), 64–73. Retrieved from https://jkmc.com.np/ojs3/index.php/journal/article/view/1080

Abstract

Background: Bacterial meningitis is a severe infection of the central nervous system with varied clinical presentations. It is associated with substantial mortality and morbidity.

Objectives: The objective of this study was to assess the clinical profile, including the clinical features, laboratory and radiological parameters, clinical course, treatment, response to treatment, complications, and outcome of children at discharge.

Methods: A prospective observational study was conducted among 52 inpatient children of acute bacterial meningitis aged one month to 14 years over a period of six months. The patients were enrolled during admission and followed up daily till discharge. Socio-demographic, clinical, and diagnostic details and outcomes were recorded and analysed using statistical package for social sciences version 20.

Results: The median age of the patients was two years with male to female ratio of 2:1. Fever (45, 87%), vomiting (37, 71%), seizure (33, 64%) and headache (22, 46%) were the most common symptoms. The cerebrospinal fluid culture was positive in three (6%) cases. Complications were seen in 20 (39%) patients including four (7.7%) deaths. Patients with prolonged fever, malnutrition, loss of consciousness, ear discharge, presence of meningeal signs, abnormal pupil, high cerebrospinal fluid protein, positive cerebrospinal fluid, and blood culture, low blood pH, and hyperlactataemia were significantly associated with complications (p <0.05).

Conclusion: Factors like malnutrition, longer duration of fever, and abnormal neurological and laboratory findings were associated with higher rates of complications.

PDF

References

Swanson D. Meningitis. Pediatr Rev. 2015 Dec;36(12):514-24; quiz 525-6. [PubMed | Full Text | DOI]

Watt JP, Wolfson LJ, O’Brien KL, Henkle E, DeloriaKnoll M, McCall N et al. Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: Global estimates. Lancet. 2009 Sep 12;374(9693):903-11. [PubMed | Full Text | DOI]

O’Brien KL, Wolfson LJ, Watt JP, Henkle E, DeloriaKnoll M, McCall N, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: Global estimates. Lancet. 2009 Sep 12;374(9693):893-902. [PubMed | Full Text | DOI]

Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis. 2010 Jan;10(1):32-42. [PubMed | Full Text | DOI]

Mann K, Jackson MA. Meningitis. Pediatr Rev. 2008 Dec;29(12):417-29; quiz 430. [PubMed | Full Text | DOI]

Shahan B, Choi EY, Nieves G. Cerebrospinal Fluid Analysis. Am Fam Physician. 2021 Apr 1;103(7):422- 8. Erratum in: Am Fam Physician. 2021 Jun 15;103(12):713. [PubMed| Full Text]

Zainel A, Mitchell H, Sadarangani M. Bacterial meningitis in children: Neurological complications, associated risk factors, and prevention. Microorganisms. 2021 Mar 5;9(3):535. [PubMed | Full Text | DOI]

Casella EB, Cypel S, Osmo AA, Okay Y, Lefèvre BH, Lichtig I, et al. Sequelae from meningococcal meningitis in children: A critical analysis of dexamethasone therapy. Arq Neuropsiquiatr. 2004 Jun;62(2B):421-8. [PubMed | Full Text | DOI]

King BA, Richmond P. Pneumococcal meningitis in Western Australian children: Epidemiology, microbiology and outcome. J Paediatr Child Health. 2004 Nov;40(11):611-5. [PubMed | Full Text | DOI]

Obiero CW, Mturi N, Mwarumba S, Ngari M, Newton CR, van Hensbroek MB et al. Clinical features of bacterial meningitis among hospitalised children in Kenya. BMC Med. 2021 Jun 4;19(1):122. [PubMed | Full Text | DOI]

Abdelrahim NA, Fadl-Elmula IM, Ali HM. Bacterial meningitis in Sudanese children; critical evaluation of the clinical decision using clinical prediction rules. BMC Pediatr. 2019 Sep 6;19(1):319. [PubMed | Full Text | DOI]

Sigaúque B, Roca A, Sanz S, Oliveiras I, Martínez M, Mandomando I, et al. Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique. Acta Trop. 2008 Jan;105(1):21-7. [PubMed | Full Text | DOI]

Rasul CH, Zaman MA, Hossain MJ, Nasrin E, Rahman M. Outcome and prognostic factors of acute meningoencephalitis in children of Southern Bangladesh. Sri Lanka J Child Health. 2013;42(1):27- 32. [Full Text | DOI]

Shrestha, RG, Tandukar S, Ansari S, Subedi A, Shrestha A, Poudel R, et al.. Bacterial meningitis in children under 15 years of age in Nepal. BMC Pediatr. 2015 Aug 19;15:94. [PubMed |Full Text | DOI]

Fitzwater SP, Ramachandran P, Nedunchelian K, Kahn G, Santosham M, Chandran A. 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 Jul;163(1 Suppl):S32-7. [PubMed | Full Text | DOI]

Moghtaderi A, Alavi-Naini R, Rashki S. Cranial nerve palsy as a factor to differentiate tuberculous meningitis from acute bacterial meningitis. Acta Med Iran. 2013 Mar 16;51(2):113-8. [PubMed | Full Text]

Kanegaye JT, Soliemanzadeh P, Bradley JS. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Pediatrics. 2001 Nov;108(5):1169-74. Erratum in: Pediatrics 2002 Sep;110(3):651. [PubMed | Full Text]

Ramakrishnan M, Ulland AJ, Steinhardt LC, Moisi JC, Were F, Levine OS. Sequelae due to bacterial meningitis among African children: a systematic literature review. BMC Med. 2009 Sep 14;7:47. [PubMed | Full Text | DOI]

Nwadioha SI, Nwokedi EO, Onwuezube I, Egesie JO, Kashibu E. Bacterial isolates from cerebrospinal fluid of children with suspected acute meningitis in a Nigerian tertiary hospital. Niger Postgrad Med J. 2013 Mar;20(1):9-13. [PubMed | Full Text]

Debnath DJ, Wanjpe A, Kakrani V, Singru S. Epidemiological study of acute bacterial meningitis in admitted children below twelve years of age in a tertiary care teaching hospital in Pune, India. Med J DY Patil Univ. 2012;5:28-30. [Full Text]

Ciofi degli Atti M, Esposito S, Parola L, Ravà L, Gargantini G, Longhi R, et al. In-hospital management of children with bacterial meningitis in Italy. Ital J Pediatr. 2014 Nov 14;40:87. [PubMed | Full Text | DOI]

Singhi P, Bansal A, Geeta P, Singhi S. Predictors of long term neurological outcome in bacterial meningitis. Indian J Pediatr. 2007 Apr;74(4):369-74. [PubMed | Full Text | DOI]

Kuti BP, Bello EO, Jegede TO, Olubosede O. Epidemiological, clinical and prognostic profile of childhood acute bacterial meningitis in a resource poor setting. J Neurosci Rural Pract. 2015;6(4):549- 57. [PubMed | Full Text | DOI]