Bacterial meningitis in children. Selected aspects

Profiles of acute bacterial meningitis isolates in children in National Hospital, Abuja

Background:

Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality throughout the world. It is an acute medical emergency that requires urgent rational antibiotic therapy, especially in neonates and young infants. Determining the pattern and susceptibility of isolates of ABM among children for prompt treatment of this important cause of mortality and morbidity is very important. This study determined the types and the antimicrobial susceptibility pattern of ABM isolates among children at the National Hospital, Abuja.

Materials and Methods:

This is a retrospective study carried out at the National Hospital Abuja (NHA), Nigeria. Laboratory data for a period of 3 years, January 2010-December 2013 were reviewed, and all bacterial isolates and their antibiotics sensitivity testing results for children aged 0-15 years, and other relevant information extracted and analyzed. Study center was the NHA.

Results:

Twenty-eight bacterial pathogens were isolated from a total of 542 cerebrospinal specimens over the study period, giving a yield of 5.2%. The four most common pathogens isolated were Staphylococcus aureus (32.2%), Klebsiella pneumoniae (21.5%), Streptococcus pneumoniae (17.6%), and Escherichia coli (14.3%). Whereas, 28.6% of all the infections occurred in neonates alone, children 2 years and below had 85.7% of all the infections, with male preponderance. Isolates of S. aureus and S. pneumonia tested were both 100% susceptible to amoxicillin-clavulanic acid and Cefuroxime; S. pneumoniae was equally sensitive to Ceftriaxone. K. pneumoniae was 100% sensitive to Imipenem, but 83% to ceftriaxone. 75% of the isolated E. coli strains were sensitive to ceftriaxone, amoxicillin-clavulanic acid, and amikacin, 100% sensitive to imipenem.

Conclusion:

Meningitis in children as seen in the National hospital is almost equally caused by both Gram-positive and Gram-negative organisms, predominantly by S. aureus, S. pneumoniae, K. pneumoniae, and E. coli. Available drugs remain active against these organisms.

Recurrent Streptococcus Pneumoniae 23 F meningitis due to cerebrospinal fluid leakage from the ear cannel: a case report

Background

Bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause. Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization with many invasive investigations.

Case presentation

A 6-year-old boy was diagnosed with recurrent bacterial meningitis caused by Streptococcus Pneumonia 23 F. He had received serial imaging studies for identifying the cause. The initial sinus computed tomography (CT) also showed sinusitis without bony defect of sinus. However, after performing nuclear scan, the results showed cerebrospinal fluid (CSF) leaked originating from the right petrooccpital region into the middle ear. Subsequent high resolution CT (HRCT) reports showed focal enlargement of the right facial nerve canal, erosion of the bony canal at geniculate ganglion and tympanic segment with tiny high-density spots. The reconstruction HRCT showed multiple bony defects at temporal bone. The magnetic resonance imaging revealed multifocal bony destruction with CSF collection in the right petrous ridge, carotid canal and jugular foramen. Eventually, CSF leakage to the right middle ear was confirmed and this could be the cause of the recurrent bacteria meningitis in this patient.

Conclusion

Although recurrent bacterial meningitis in childhood is not common, this case report illustrates that recurrence of meningitis within a short period should be considered as cause of underline immunologic or anatomic defect.

Treatment-resistant meningitis leading to the diagnosis of Currarino syndrome: a case report

A 20-day-old female infant developed fever. Sepsis evaluation revealed cerebrospinal fluid (CSF) pleocytosis and a modestly decreased CSF glucose. After 48 hours of broad-spectrum antibiotics, the infant remained febrile. Repeat CSF analysis showed increased pleocytosis and a very low glucose value. Subsequently, a rectothecal fistula and sacral abnormalities were found, leading to the diagnosis of Currarino syndrome. Parameningeal foci should be considered in treatment-resistant meningitis.

Recurrent meningitis caused by cervico-medullary abscess, a rare presentation

BACKGROUND

Recurrent bacterial meningitis is usually a complication of cranial anatomical defect or the result of impaired humoral immunity, notably, defects of the complement system and agammaglobulinemia. It could present a diverse range of symptoms.

DISCUSSION

Meningitis as a presentation of intramedullary abscess is not common. Here we present a 7-year-old boy with recurrent meningitis as the first manifestation of an underlying upper cervical cord abscess.

Macrocephaly, increased intracranial pressure, and hydrocephalus in the infant and young child

Macrocephaly, increased intracranial pressure, and hydrocephalus are common related conditions that lead to cross-sectional imaging of the infant and young child. Imaging plays a central role in establishing the diagnosis and guiding disposition and treatment of these patients. In this review, a general overview is provided, and the more common causes of hydrocephalus are presented, including posthemorrhage, postinfection, developmental malformations, and masses. Imaging guidelines are also outlined for initial evaluation and follow-up, along with a discussion of the imaging features of shunt malfunction.

Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae and Streptococcus sp. by polymerase chain reaction for the diagnosis of bacterial meningitis

The simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus sp. was assessed by polymerase chain reaction (PCR) for the diagnosis of bacterial meningitis, as well as the applicability of PCR as a routine test. A cohort study was carried out with 182 children (2 months to 12 years of age) with suspicion of bacterial meningitis. Routine tests identified the etiologic agent in 65/84 children whose clinical status and laboratory findings suggested the presence of bacterial meningitis. Bacterial meningitis was ruled out in 98 children. In 19 children, the etiologic diagnosis was not possible using standard methods; in 14 of these patients, the etiologic agent was identified by PCR (N. meningitidis=12; H. influenzae=1; Streptococcus sp.=1). The sensitivity of PCR was 88.1%; specificity, 99.0%; positive predictive value, 98.7%; and negative predictive, 90.1%. PCR is a useful complementary diagnostic technique, especially when Gram stain, culture, or antigenic detection are negative or inconclusive.

[Etiology of bacterial meningitis in a cohort from Salvador, Bahia]

Bacterial meningitis remains a very important disease world-wide, mainly during childhood. In order to describe the etiology of bacterial meningitis among some children in Salvador, Bahia-Brazil, we retrospectively reviewed 7000 cerebrospinal fluid exams, performed within the period of September 1988 up to August 1995, at the CSF Laboratory, José Silveira Foundation; 892(12.7%) exams met the inclusion criteria; patients less than 16 years of age and clinical meningitis diagnosis. Among 139 cases of bacterial meningitis, H. influenzae type b (Hib) was the most frequent cause (26.0%), all of the cases in children under 5 years. We have been questioning whether the declining Hib disease trend since 1992 has been associated with the use of Hib conjugate vaccines among those children.