PYOGENIC MENINGITIS IN INFANCY AND CHILDHOOD

Dexamethasone as an adjunctive treatment of bacterial meningitis

This study was conducted on 77 Libyan infants and children aged month to 10 years with acute bacterial meningitis. Upon admission, the patients were divided randomly in two groups. Group I (38 patients) received ceftriaxone plus dexamethasone i.v. Group II (39 patients) received ceftriaxone alone. Both groups were compared for mean changes in CSF sugar, CSF protein and CSF polymorph count at 4th day of treatment. There was a significant difference between the two groups in CSF sugar and protein changes (P < 0.05) but not in CSF polymorph (P > 0.05). Both groups showed prompt clinical response and similar occurrence of acute complications, fatality rate and permanent neurological sequelae. However, group I manifested shorter duration of fever (P < 0.05). Dexamethasone improved the inflammatory reaction in acute bacterial meningitis and shortened the duration of fever but it did not have any significant effect on the fatality and the occurrence of neurological sequelae of this disease.

Pyogenic meningitis in Ahmedabad

One hundred and thirty five cerebrospinal fluid (CSF) samples from children clinically diagnosed Pyogenic meningitis (in and around Ahmedabad) were subjected to physical, bacteriological, cytological and biochemical examinations. It was found that all CSF specimens were turbid, the culture positivity varied form 12.12 to 56%. The highest percentage was found in children of less than one year of age. The average percentage of culture positivity was 28.68%. The result of gram stain was more than that of cultural examination. Gram stain of CSF was specific, accurate and highly valuable in the diagnosis of pyogenic meningitis. Among gram positive organisms isolated, Staphylococcus aureus was highest (8.8%) followed by Diplococcus pneumoniae (3.7%), but Klebsiella was predominant (6.6%) among gram negative bacilli. Staph. aureus was 100% sensitive to erythromycin, gentamycin, kanamycin and ampicillin. The results of cytological and biochemical tests correlated (67.1%). There was increase in polymorphs and protein, sugar levels decreased.

Pneumococcal meningitis and bacteraemia in Danish children 1969-1978. Serotypes, incidence and outcome

The incidence of pneumococcal meningitis in Danish children during 1969-1978 was estimated to be 2.1/year/100,000 children from 0 to 14 years old. Fifty-five per cent of 146 children with pneumococcal meningitis and 61% of 61 with bacteraemia were below 2 years of age. Mortality from meningitis was 13% and from bacteraemia 7%. Of the children with meningitis, 14% had sequelae at the time of discharge from the hospital. Sequelae were not seen after bacteraemia. Among 277 pneumococcal isolates from spinal fluid and blood from Danish children during 1969-1978, serotypes 14, 18C, 6A + 6B, 23F, 7F and 19F, in that order of frequency, were the most common ones, accounting for 69% of all isolates. Serotypes included in current 14-valent pneumococcal polysaccharide vaccines made of 80% of all types, when types 6A and 6B are considered together (because it has been shown that they offer cross-protection).

Amoxycillin injection in the treatment of pyogenic meningitis in children

An open trial of the use of amoxycillin injection in the treatment of pyogenic meningitis in children showed similar results to previous trials here of penicillin-chloramphenicol combinations. It is felt that, in developing countries at least, treatment of pyogenic meningitis in children should be with the latter combination, but where rapid and accurate bacteriology is available amoxycillin may be valuable non-toxic alternative to chloramphenicol with similar activity to ampicillin.

Acute bacterial meningitis in childhood. Incidence and mortality in a defined population

Cases of acute bacterial (excluding tuberculous) meningitis and meningococcal infection, occurring in children under 10 years of age in the North-West Metropolitan region between 1969 and 1973 have been studied retrospectively by case-note review. The risk of having an acute meningococcal infection was estimated to be 1 in 1090, and that of having an attack of haemophilus meningitis to be 1 in 1500, but the age of 10 years. The case-fatality rates for meningococcal infection, haemophilus meningitis, and pneumococcal meningitis were 10.9%, 5.7%, and 16.4% respectively. Meningitis was not diagnosed in life in 26 of 94 fatal cases (28%).

Ventriculoauriculostomy-associated infection. A 12-year study

✓ A series of 102 newly referred and uninfected patients on whom 299 operative procedures to insert ventriculoauricular cerebrospinal fluid shunts were performed over a 12-year period were studied for the rate and cause of associated sepsis. It was found that 15.7% of the shunt insertions were followed by infection, and 1.3% of the revisions, for an overall infection rate of 14%. There were two clinical groups, those who developed acute postoperative infections (9%) and those with delayed infections developing 1 month to 6 years after operation (5%). The causes of the infections are discussed. It is suggested that careful follow-up with frequent blood cultures will reveal more infected cases in the delayed group, and that bacteriocidal agents selected for the specific organism should be maintained in cerebrospinal fluid and blood for long periods.