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Chamkhaleh MA, Noorbakhsh S, Vafaee-Shahi M, Riahi A, Hajinasab N, Gandomi-Mohammadabadi A, Shiasi M. The Epidemiology and Outcomes of Meningitis among Iranian Children in a Period of 10 Years. Open Neurol J 2021. [DOI: 10.2174/1874205x02115010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
One of the important causes of childhood febrile illness is meningitis. It causes bacterial, viral, fungal, parasitic, and non-infectious agents. Pediatric bacterial meningitis is one of the most important causes of infant mortality, especially in premature infants. This study aimed to identify the outcome and mortality of children with meningitis.
Methods and Materials:
All children with meningitis in the Pediatric Department of Rasool Akram Hospital from December 23, 2007, to December 16, 2017, were included. Signs and symptoms (fever, consciousness, neck rigidity, and seizure) were collected and Cerebrospinal fluid analysis in children was made. Based on these findings, patients were divided into two groups, which include bacterial and non-bacterial meningitis. Then we recalled all families and examined them to discover the child’s outcome and complications at least after two years.
Results:
During the ten-year study period, 202 children were included in the study. Patients aged less than 12 months were found to be more frequently affected. Fever was the most common presentation (83.4%) followed by seizure (51.5%) and vomiting (49%). 119 (58.9%) of the patients were male and 83 (41.1%) were female. Definite bacterial meningitis was the final diagnosis in 35.6% (72) of patients (mean age 34.1± 48.3 months), and non-bacterial meningitis was diagnosed in 64.4% (130) of cases (mean age 46.3± 52.4 months). The most common organism in bacterial meningitis (by all methods) was Streptococcus pneumonia. Among children, 187 (92.1%) were survivors and 15 (%7.9) were non-survivors. Neurological sequelae such as motor deficit and epilepsy were identified in 9 (4.8%) and 5 (2.6%) subjects, respectively, and that they were all caused by bacterial meningitis. There was no death or neurological sequelae observed during follow-up in children with non-bacterial meningitis. Gender, age, signs and symptoms of patients at the time of admission were not significantly different between the bacterial and non-bacterial meningitis groups (p>0.05). Hydrocephalus, CSF characteristic, morbidity and mortality were significantly different between the bacterial and non-bacterial meningitis groups.
Conclusion:
This study showed that elevated LDH and low glucose levels in CSF are characteristic of bacterial meningitis. Increased LDH is significantly related to death in children (P-value > 0.001) with meningitis. Beneficial empirical antibiotics and sufficient follow-up by parents cause good prognosis in children with meningitis. Also in a child with fever and seizure, we should think of meningitis, even though in the absence of positive neurological examinations. It seems that increased CSF LDH, elevated CSF protein and age under one year are significant mortality risk factors in children with meningitis.
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Oligbu G, Collins S, Djennad A, Sheppard CL, Fry NK, Andrews NJ, Borrow R, Ramsay ME, Ladhani SN. Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000-June 30, 2016. Emerg Infect Dis 2020; 25:1708-1718. [PMID: 31441745 PMCID: PMC6711218 DOI: 10.3201/eid2509.180747] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the effects of the 7-valent (PCV7) and 13-valent (PCV13) pneumococcal conjugate vaccines on pneumococcal meningitis in England and Wales during July 1, 2000–June 30, 2016. Overall, 84,473 laboratory-confirmed invasive pneumococcal disease cases, including 4,160 (4.9%) cases with meningitis, occurred. PCV7 implementation in 2006 did not lower overall pneumococcal meningitis incidence because of replacement with non–PCV7-type meningitis incidence. Replacement with PCV13 in 2010, however, led to a 48% reduction in pneumococcal meningitis incidence by 2015–16. The overall case-fatality rate was 17.5%: 10.7% among patients <5 years of age, 17.3% among patients 5–64 years of age, and 31.9% among patients >65 years of age. Serotype 8 was associated with increased odds of death (adjusted odds ratio 2.9, 95% CI 1.8–4.7). In England and Wales, an effect on pneumococcal meningitis was observed only after PCV13 implementation. Further studies are needed to assess pneumococcal meningitis caused by the replacing serotypes.
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Berangi Z, Karami M, Mohammadi Y, Nazarzadeh M, Zahraei SM, Javidrad H, Heidari S. Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction. BMC Pediatr 2019; 19:370. [PMID: 31640619 PMCID: PMC6806508 DOI: 10.1186/s12887-019-1741-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No reliable and comprehensive study has been published on the incidence and epidemiological profile of meningitis in Iran from 2008 to 2014, before pneumococcal conjugate vaccine (PCV) and pentavalent vaccine (DTPw-Hep B-Hib (PRP-T) vaccine (pentavac) (adsorbed)) introduction. The present study aimed to portray the epidemiological profile of meningitis in Iran from 2008 to 2014. METHODS Data on meningitis cases aged from 1 day to 110 years were extracted from national notifiable diseases surveillance system from March 2008 to December 2014 in Iran. A total number of 48,006 cases of suspected meningitis were identified and 1468 cases of which met the criteria for diagnosis-confirmed meningitis. Of 1468 cases, 1352 patients were included in the study. RESULTS The great number of cases reported from urban areas. Moreover, males were more predominant than females (58.51% vs. 33.81%) in total. The estimated annual incidence rate of meningitis varied from 0.28/100000 in 2008 to 0.09/100000 in 2014. Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis were the most leading pathogens causing bacterial meningitis, accounted for 266(23.44%), 145(12.78%), 95(8.37%) of cases, respectively. Each of the three bacterial species showed a descending trend. The majority of infected subjects are children under five years. CONCLUSIONS Unlike the decreasing trend of meningitis and high percentage of cultures with negative results, according to World Health Organization recommendation PCV introduction into routine immunization is evident. Implementing an enhanced surveillance system to provide high quality data on epidemiological profile of meningitis in Iran is necessary.
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Affiliation(s)
- Zeinab Berangi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran
| | - Manoochehr Karami
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran. .,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Younes Mohammadi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Milad Nazarzadeh
- George Institute for Global Health, University of Oxford, Oxford, UK
| | - Seyed Mohsen Zahraei
- Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran
| | - Hamidreza Javidrad
- Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran
| | - Saber Heidari
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran
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Role of spinal ultrasound in diagnosis of meningitis in infants younger than 6 months. Eur J Radiol 2014; 84:469-473. [PMID: 25533721 DOI: 10.1016/j.ejrad.2014.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/25/2014] [Accepted: 11/14/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spinal ultrasound (US) can detect changes in CSF echogenicity and decreased cord pulsations which reflect the inflammatory changes in meningitis. Till date, there is no published data about the prospective accuracy of spinal US in meningitis. OBJECTIVE To assess accuracy of spinal US in diagnosis of meningitis in infants younger than 6 months. METHODS This was an institute ethics committee approved prospective study carried out in infants less than 6 months of age with clinical suspicion of meningitis who presented to pediatric emergency unit. 60 infants each in study and control group were enrolled. US of thoraco-lumbar spine were performed prior to lumbar puncture in all cases. We looked for the presence of echogenicity or trabeculations in posterior subarachnoid space and for presence or absence of spinal cord and nerve root pulsations on real time ultrasound. The results of spinal US were evaluated in correlation with cerebrospinal fluid analysis. Follow up ultrasounds were done in infants who showed abnormal findings after the initiation of treatment and findings compared with initial results. RESULTS The study group comprised of 40 boys and 20 girls with mean age of 47.85 days. The control group comprised of 36 boys and 24 girls with a mean age of 60.53 days. 34/60 cases in study group had CSF findings suggestive of meningitis. Based on imaging parameters, spinal US had sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 67.16%, 92.3%, 93.1% and 74.64%, respectively. Chi-square test showed a statistically significant association between infants with meningitis and positive US findings (p<0.05). CONCLUSION Spinal US findings of CSF debris, septations and decreased spinal cord pulsations can be seen in infants with meningitis.
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Long-term effects from bacterial meningitis in childhood and adolescence on postural control. PLoS One 2014; 9:e112016. [PMID: 25405756 PMCID: PMC4236047 DOI: 10.1371/journal.pone.0112016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/12/2014] [Indexed: 11/19/2022] Open
Abstract
Bacterial meningitis in childhood is associated with cognitive deficiencies, sensorimotor impairments and motor dysfunction later in life. However, the long-term effects on postural control is largely unknown, e.g., whether meningitis subjects as adults fully can utilize visual information and adaptation to enhance stability. Thirty-six subjects (20 women, mean age 19.3 years) treated in childhood or adolescence for bacterial meningitis, and 25 controls (13 women, mean age 25.1 years) performed posturography with eyes open and closed under unperturbed and perturbed standing. The meningitis subjects were screened for subjective vertigo symptoms using a questionnaire, clinically tested with headshake and head thrust test, as well as their hearing was evaluated. Meningitis subjects were significantly more unstable than controls during unperturbed (p≤0.014) and perturbed standing, though while perturbed only with eyes open in anteroposterior direction (p = 0.034) whereas in lateral direction both with eyes open and closed (p<0.001). Meningitis subjects had poorer adaption ability to balance perturbations especially with eyes open, and they frequently reported symptoms of unsteadiness (88% of the subjects) and dizziness (81%), which was found significantly correlated to objectively decreased stability. Out of the 36 subjects only 3 had unilateral hearing impairment. Hence, survivors of childhood bacterial meningitis may suffer long-term disorders affecting postural control, and would greatly benefit if these common late effects became generally known so treatments can be developed and applied.
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Epidemiology and drug resistance profile of acute bacterial meningitis in children in Northern India: a university hospital perspective. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60734-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Levy C, Varon E, Taha MK, Béchet S, Bonacorsi S, Cohen R, Bingen E. Évolution des méningites bactériennes de l’enfant en France sous l’effet des vaccinations. Arch Pediatr 2014; 21:736-44. [DOI: 10.1016/j.arcped.2014.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/17/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Abstract
Bacterial meningitis remains important cause of morbidity and mortality worldwide, particularly in developing countries. This study analyzed the data from sentinel surveillance for bacterial meningitis among children <5 years of age hospitalized in largest children's hospital in Tbilisi, capital of Georgia and adult patients hospitalized in infectious diseases hospital during 2006-2010 with suspected bacterial meningitis. The surveillance is conducted by National Center for Disease Control and Public Health (NCDCPH). The number of patients with identified organism was 127 (19 %). In the subsample of patients with laboratory confirmed bacterial meningitis Streptococcus pneumoniae was the most frequently isolated organism (67 cases, 52.8 %), followed by. influenza (17 cases, 13.4 %) and Neisseria meningitidis (16 cases, 12.6 %). The number of patients with suspected TB meningitis was 27 (21.3 %). The overall case fatality rate in the subgroup of patients with identified organism was 12.3 %. The highest mortality was observed among TB patients (22.2 %) with 14.3 % mortality for N. meningitidis and 10.3 % for S. pneumoniae. No lethal outcome was observed among patients with Haemophilus influenzae.
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Prasad R, Kapoor R, Srivastava R, Mishra OP, Singh TB. Cerebrospinal fluid TNF-α, IL-6, and IL-8 in children with bacterial meningitis. Pediatr Neurol 2014; 50:60-5. [PMID: 24138950 DOI: 10.1016/j.pediatrneurol.2013.08.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/26/2013] [Accepted: 08/18/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the levels of cerebrospinal fluid concentrations of tumor necrosis factor-α, interleukin-6, and interleukin-8 in bacterial meningitis in children. METHODS The study included children up to 14 years of age admitted to a pediatric ward with fever, headache, vomiting, and seizures. The diagnosis of bacterial meningitis was based on clinical features: physical examination, blood and cerebrospinal fluid cytochemical findings, Gram stain, and bacterial culture. The cerebrospinal fluid levels of tumor necrosis factor-α, interleukin-6, and interleukin-8 were measured in 57 children with bacterial meningitis, 15 with viral meningitis, and 15 controls by enzyme-linked immunosorbent assay methods. RESULTS The mean concentrations of cerebrospinal fluid, tumor necrosis factor-α, interleukin-6, and interleukin-8 were 1108 ± 183, 652 ± 287, and 442 ± 120 pg/mL, respectively, in children with bacterial meningitis and were significantly increased in those in the viral meningitis group (tumor necrosis factor-α : 711 ± 105, IL-6 : 272 ± 161, IL-8 : 175 ± 62 pg/mL; P < 0.001) or control (390 ± 37, 59 ± 17, 19 ± 13 pg/mL, respectively, P < 0.001). At optimum cutoff level based on the receiver operating characteristic curve, cerebrospinal fluid cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-8) showed sensitivity and specificity of 100% for the diagnosis of bacterial meningitis. For differentiation of bacterial from viral meningitis, cerebrospinal fluid level of tumor necrosis factor-α, IL-6, and IL-8 showed sensitivity and specificity of 94.7% and 86.7%, 80.7% and 53.3%, and 89.5% and 86.7%, respectively. CONCLUSION The increased concentration of cerebrospinal fluid tumor necrosis factor-α, interleukin-6, and interleukin-8 in children with meningitis suggests a role in the pathogenesis of bacterial meningitis and these levels might prove to be useful in children whose diagnosis is in question.
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Affiliation(s)
- Rajniti Prasad
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Rishi Kapoor
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ragini Srivastava
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Om Prakash Mishra
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Tej Bali Singh
- Department of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Tin Tin Htar M, Madhava H, Balmer P, Christopoulou D, Menegas D, Bonnet E. A review of the impact of pneumococcal polysaccharide conjugate vaccine (7-valent) on pneumococcal meningitis. Adv Ther 2013; 30:748-62. [PMID: 24000099 PMCID: PMC3778885 DOI: 10.1007/s12325-013-0051-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Streptococcus pneumoniae is the leading cause of bacterial meningitis. Young children, the elderly and those who are immunocompromised or who suffer from chronic diseases have the highest risk of developing pneumococcal meningitis. A 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in 2000 in the US and in 2001 in Europe. METHODS A literature search was performed in PubMed to identify studies assessing the impact of routine childhood PCV7 vaccination on pneumococcal diseases. Here, we report the impact on pneumococcal meningitis. RESULTS A total of 17 articles reporting impact data on pneumococcal meningitis were included in this review: 11 from Western Europe and 6 from North America. In the post-vaccination period, compared with the pre-vaccination period, a reduction ranging from 59.2% in the US, 1 year after vaccine introduction, to 100% in Belgium, 4 years after vaccine introduction in vaccine-type (VT) pneumococcal meningitis incidence was reported in vaccine-eligible children in seven studies. In addition, the majority of studies reported reductions in VT and all-type pneumococcal meningitis incidence in age groups that were not vaccine-eligible. CONCLUSIONS The results from this review demonstrate that PCV7 has had a significant impact on pneumococcal meningitis across all ages through its use in pediatric immunization programs. With the introduction of 13-valent PCV (PCV13) we can expect to see a reduction in the incidence of pneumococcal meningitis due to the six additional serotypes included, as well as continued protection against pneumococcal meningitis due to PCV7 serotypes. Robust surveillance systems are essential for the evaluation of the impact of PCV13 on all-type pneumococcal meningitis and for monitoring the evolution of non-vaccine serotype pneumococcal meningitis.
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Affiliation(s)
- Myint Tin Tin Htar
- Pfizer ESAT Vaccines, 23-25 Avenue du Docteur Lannelongue, 75014, Paris, France,
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Pace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine 2012; 30 Suppl 2:B3-9. [PMID: 22607896 DOI: 10.1016/j.vaccine.2011.12.062] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/10/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
The clinical spectrum of invasive meningococcal disease is diverse with meningitis and/or septicaemia being the commonest modes of presentation. The severity of manifestations of meningococcal infection ranges from bacteraemia, associated with mild non-specific symptoms, to fulminant sepsis with multiorgan failure and death in approximately 10-15% of cases. Localised infections (such as conjunctivitis or septic arthritis) as well as chronic disease may be the sole clinical manifestations but can also lead to disseminated fulminant disease. Among survivors, disabling long-term sequelae can complicate meningococcal disease and result in potentially devastating effects on the quality of life of survivors, most of whom are infants, children and adolescents. The only rational approach to the prevention of meningococcal disease and the associated human suffering is through vaccination.
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Affiliation(s)
- David Pace
- Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta.
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Association of meningococcal phenotypes and genotypes with clinical characteristics and mortality of meningitis in children. Pediatr Infect Dis J 2010; 29:618-23. [PMID: 20168263 DOI: 10.1097/inf.0b013e3181d3ce32] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neisseria meningitidis meningitis represents approximately one-half of the meningococcal cases in French children. To explore the contribution of bacterial typing in improving the management of cases, we aimed to describe clinical characteristics and mortality of meningococcal meningitis in children reported to the multicenter survey system, GPIP/ACTIV, in association with phenotypes/genotypes of bacterial isolates. METHODS From 2001 to 2005, 259 pediatric wards and 168 microbiology laboratories enrolled all children with bacterial meningitis. Risk factors, vaccination status, signs and symptoms, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. RESULTS A total of 962 cases of Neisseria meningitidis meningitis among a total of 2131 bacterial meningitis (45%) were recorded (mean age, 4.5 +/- 4.7 years). Serogroup distribution of the isolates was 62.3%, 33.7%, 2.9%, 0.6%, and 0.6% for serogroups B, C, W135, A and Y, respectively. The major clonal complexes were ST-41/44 (32.2%), ST-11 (21.9%), ST-32 (20.8%), ST-8 (8.2%), and ST-269 (4.9%). Despite global heterogeneity of the isolates, 2 phenotypes/genotypes were of interest. Isolates of the phenotype/genotype B:14:P1.7,16/ST-32 (56% clustered in the region of Haute Normandie) were observed in older children (8.6 years) and were associated with a higher case fatality rate (12%) than were other phenotypes of serogroup B. The phenotype/genotype C:2a:P1.5/ST-11 was found in 26.3% of serogroup C cases and was possibly associated with a higher mortality among serogroup C (9.9% for C and 5.9% for B, P = 0.04). CONCLUSIONS This large survey provides data that could be important for implementation of future vaccines. Typing of meningococcal isolates could contribute to an understanding of prognosis in meningococcal meningitis.
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Cho HK, Lee H, Kang JH, Kim KN, Kim DS, Kim YK, Kim JS, Kim JH, Kim CH, Kim HM, Park SE, Oh SH, Chung EH, Cha SH, Choi YY, Hur JK, Hong YJ, Lee HJ, Kim KH. The causative organisms of bacterial meningitis in Korean children in 1996-2005. J Korean Med Sci 2010; 25:895-9. [PMID: 20514311 PMCID: PMC2877225 DOI: 10.3346/jkms.2010.25.6.895] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 12/07/2009] [Indexed: 11/26/2022] Open
Abstract
Bacterial meningitis remains a serious cause of morbidity and mortality in childhood, despite the availability of effective vaccines against Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae. The purpose of this study was to analyze data on bacterial meningitis cases in Korea from 1996 through 2005. The information of all hospitalized bacteria-proven meningitis cases was obtained from 17 university hospitals nationwide. A total of 402 cases were identified. Of these, 125 (29.9%) cases were neonates. Streptococcus agalactiae was the most common bacteria responsible for 99 (24.6%) of all cases regardless of age, followed by S. pneumoniae for 91 (22.6%) and H. influenzae for 67 (16.7%) patients. The common etiology beyond the neonatal period was S. pneumoniae for 91 (33.0%) followed by H. influenzae for 63 (22.8%) patients. The overall case fatality rate was 9.4%, which was similar with that in 1986-1995. In conclusion, S. agalactiae, S. pneumoniae and H. influenzae were important etiologic agents of bacterial meningitis in children in the last 10 yrs. It is required to establish the preventive strategy of the three bacteria. The nationwide epidemiologic study should be continued to evaluate immunization strategy and efficacy.
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Affiliation(s)
- Hye Kyung Cho
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyunju Lee
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Nam Kim
- Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
| | - Dong Soo Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Kyung Kim
- Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea
| | - Jung Soo Kim
- Department of Pediatrics, Chonbuk National University, College of Medicine, Jeonju, Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hwi Kim
- Department of Pediatrics, College of Medicine, Soonchunhyang University, Bucheon, Korea
| | - Hwang Min Kim
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Su-Eun Park
- Department of Pediatrics, School of Medicine, Busan National University, Busan, Korea
| | - Sung Hee Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Ho Cha
- Department of Pediatrics, Kyunghee University School of Medicine, Seoul, Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Kyun Hur
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hyo Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
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Levy C, de La Rocque F, Cohen R. Actualisation de l’épidémiologie des méningites bactériennes de l’enfant en France. Med Mal Infect 2009; 39:419-31. [DOI: 10.1016/j.medmal.2009.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Snedecor SJ, Strutton DR, Ciuryla V, Schwartz EJ, Botteman MF. Transmission-dynamic model to capture the indirect effects of infant vaccination with Prevnar (7-valent pneumococcal conjugate vaccine (PCV7)) in older populations. Vaccine 2009; 27:4694-703. [PMID: 19520197 DOI: 10.1016/j.vaccine.2009.05.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 05/13/2009] [Accepted: 05/21/2009] [Indexed: 11/26/2022]
Abstract
We developed an age-structured, transmission-dynamic, mathematical model to quantify the direct and indirect benefits of infant PCV7 vaccination. The model simulates the acquisition of asymptomatic carriage of Streptococcus pneumoniae and the development of fatal and non-fatal invasive pneumococcal disease (IPD) among vaccinated and unvaccinated individuals aged <2, 2-4, 5-17, 18-49, 50-64, and >or=65 years old. The model was parameterized using published US surveillance data, supplemented with data from published literature. The model predicts the observed incidence of IPD with good agreement and may be used to predict the impact of various vaccination strategies in the US or other populations yet to introduce PCV7.
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Grimprel E. [Corticosteroids in children with bacterial meningitis: indications and administration]. Med Mal Infect 2009; 39:539-46. [PMID: 19394773 DOI: 10.1016/j.medmal.2009.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 11/19/2022]
Abstract
The use of dexamethasone (DXM) as adjunctive therapy for bacterial meningitis (BM) in infants and children has remained controversial for 20 years. In spite of solid pathophysiological arguments, the limited number of patients, methodological flaws in clinical studies taken individually and pooled into meta-analyses, and the emergence of pneumococcal cephalosporin-resistance did not allow to reach a consensus on the effectiveness of DXM in the prevention of neurological sequelae, in the course of non Haemophilus influenzae b (Hib) BM. A recent meta-analysis conducted with an adequate number of patients (2,750 patients including 2,074 infants and children below 15 years of age) demonstrated that DXM prevented mortality and sequelae in adults with pneumococcal meningitis and suggested that this efficacy could also apply to infants and children. Data from the active surveillance networks of pediatric BM and pneumococcal resistance in France suggested that DXM anti-inflammatory effect on antibiotic CSF penetration would not have a significant impact on the bactericidal efficacy if recommended dosages of cefotaxime (300 mg/kg per day) and vancomycin (60 mg/kg per day) were used. DXM could be considered in the early treatment of pneumococcal BM in infants and children in industrialized countries. But there is no proven efficacy of DXM in meningococcal meningitis in infants and children.
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Affiliation(s)
- E Grimprel
- Groupe de pathologie infectieuse pédiatrique de la Société française de pédiatrie, France.
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Yanni E, Grosse SD, Yang Q, Olney RS. Trends in pediatric sickle cell disease-related mortality in the United States, 1983-2002. J Pediatr 2009; 154:541-5. [PMID: 19028391 DOI: 10.1016/j.jpeds.2008.09.052] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 09/03/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze trends in sickle cell disease (SCD)-related mortality among black children during 1983-2002. STUDY DESIGN Using the multiple-cause mortality files compiled by the Centers for Disease Control and Prevention's National Center for Health Statistics, we analyzed deaths among children classified as black who were age 14 years and younger and had SCD identified on their death certificates. RESULTS Relative to the rate for 1983-1986, the SCD mortality rate for 1999-2002 decreased by 68% (95% confidence interval [CI]=58% to 75%) at age 0 to 3 years, by 39% (95% CI=16% to 56%) at age 4 to 9 years, and by 24% (95% CI= -9% to 47%) at age 10 to 14 years. For the most recent period studied, a significant (42%) reduction in mortality at age 0 to 3 years was seen between 1995-1998 and 1999-2002, with essentially no reduction in SCD mortality at older ages. CONCLUSIONS Recent decreases in SCD mortality in black children under age 4 years coincided with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000, although temporal association is not evidence of causation. The lack of significant recent reduction in SCD mortality in older children indicates the need for new treatment approaches.
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Affiliation(s)
- Emad Yanni
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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18
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Giorgi Rossi P, Mantovani J, Ferroni E, Forcina A, Stanghellini E, Curtale F, Borgia P. Incidence of bacterial meningitis (2001-2005) in Lazio, Italy: the results of a integrated surveillance system. BMC Infect Dis 2009; 9:13. [PMID: 19196453 PMCID: PMC2645407 DOI: 10.1186/1471-2334-9-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 02/05/2009] [Indexed: 11/17/2022] Open
Abstract
Background Monitoring the incidence of bacterial meningitis is important to plan and evaluate preventive polices. The study's aim was to estimate the incidence of bacterial meningitis by aetiological agent in the period 2001–2005, in Lazio Italy (5.3 mln inhabitants). Methods Data collected from four sources – hospital surveillance of bacterial meningitis, laboratory information system, the mandatory infectious diseases notifications, and hospital information system – were combined into a single archive. Results 944 cases were reported, 89% were classified as community acquired. S. pneumoniae was the most frequent aetiological agent in Lazio, followed by N. meningitis. Incidence of H. influenzae decreased during the period. 17% of the cases had an unknown aetiology and 13% unspecified bacteria. The overall incidence was 3.7/100,000. Children under 1 year were most affected (50.3/100.000), followed by 1–4 year olds (12.5/100,000). The percentage of meningitis due to aetiological agents included in the vaccine targets, not considering age, is 31%. Streptococcus spp. was the primary cause of meningitis in the first three months of life. The capture-recapture model estimated underreporting at 17.2% of the overall incidence. Conclusion Vaccine policies should be planned and monitored based on these results. The integrated surveillance system allowed us to observe a drop in H. influenzae b meningitis incidence consequent to the implementation of a mass vaccination of newborns.
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Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS, Farley MM, Jorgensen JH, Lexau CA, Petit S, Reingold A, Schaffner W, Thomas A, Whitney CG, Harrison LH. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 2009; 360:244-56. [PMID: 19144940 PMCID: PMC4663990 DOI: 10.1056/nejmoa0800836] [Citation(s) in RCA: 345] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Invasive pneumococcal disease declined among children and adults after the introduction of the pediatric heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, but its effect on pneumococcal meningitis is unclear. METHODS We examined trends in pneumococcal meningitis from 1998 through 2005 using active, population-based surveillance data from eight sites in the United States. Isolates were grouped into PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), PCV7-related serotypes (6A, 9A, 9L, 9N, 18A, 18B, 18F, 19B, 19C, 23A, and 23B), and non-PCV7 serotypes (all others). Changes in the incidence of pneumococcal meningitis were assessed against baseline values from 1998-1999. RESULTS We identified 1379 cases of pneumococcal meningitis. The incidence declined from 1.13 cases to 0.79 case per 100,000 persons between 1998-1999 and 2004-2005 (a 30.1% decline, P<0.001). Among persons younger than 2 years of age and those 65 years of age or older, the incidence decreased during the study period by 64.0% and 54.0%, respectively (P<0.001 for both groups). Rates of PCV7-serotype meningitis declined from 0.66 case to 0.18 case (a 73.3% decline, P<0.001) among patients of all ages. Although rates of PCV7-related-serotype disease decreased by 32.1% (P=0.08), rates of non-PCV7-serotype disease increased from 0.32 to 0.51 (an increase of 60.5%, P<0.001). The percentages of cases from non-PCV7 serotypes 19A, 22F, and 35B each increased significantly during the study period. On average, 27.8% of isolates were nonsusceptible to penicillin, but fewer isolates were nonsusceptible to chloramphenicol (5.7%), meropenem (16.6%), and cefotaxime (11.8%). The proportion of penicillin-nonsusceptible isolates decreased between 1998 and 2003 (from 32.0% to 19.4%, P=0.01) but increased between 2003 and 2005 (from 19.4% to 30.1%, P=0.03). CONCLUSIONS Rates of pneumococcal meningitis have decreased among children and adults since PCV7 was introduced. Although the overall effect of the vaccine remains substantial, a recent increase in meningitis caused by non-PCV7 serotypes, including strains nonsusceptible to antibiotics, is a concern.
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Tsai MH, Chen SH, Hsu CY, Yan DC, Yen MH, Chiu CH, Huang YC, Lin TY. Pneumococcal meningitis in Taiwanese children: emphasis on clinical outcomes and prognostic factors. J Trop Pediatr 2008; 54:390-4. [PMID: 18701519 DOI: 10.1093/tropej/fmn046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pneumococcal meningitis causes high morbidity or mortality in childhood despite the progress in medicine. Children with pneumococcal meningitis were identified and retrospectively reviewed. Forty-nine children were eligible, with mortality in 24.5% of all and neurological sequelae in 40.5% of survivors. In the analysis of clinical profiles, ventilator support (p = 0.001), septic shock (p < 0.001), multiple organ failure (p < 0.001) and lower cerebrospinal fluid (CSF) leukocyte count (p = 0.001) were more frequently found in non-survivors. Besides, CSF protein (p = 0.006) was higher in survivors with neurological sequelae. Initial dexamethasone usage and disease severity did not affect the occurrence of neurological sequelae. Multivariate logistic regression analysis revealed that CSF leukocyte count <or=200 mm(-3) (p = 0.013) and protein level >or=330 g l(-1) (p = 0.022) were significantly risk factors associated with poor outcomes, and physicians should be cautious if such conditions occur.
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Affiliation(s)
- Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan
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21
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Epidemiology and outcomes of bacterial meningitis in Mexican children: 10-year experience (1993–2003). Int J Infect Dis 2008; 12:380-6. [DOI: 10.1016/j.ijid.2007.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 09/18/2007] [Indexed: 11/19/2022] Open
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22
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Dagan R. Use of Pneumococcal Conjugate Vaccine to Decrease Rates of Bacterial Meningitis. Clin Infect Dis 2008; 46:1673-6. [DOI: 10.1086/587898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
BACKGROUND Few data exist regarding the test characteristics of cerebrospinal fluid (CSF) Gram stain among children at risk for bacterial meningitis, especially the rate of false positive Gram stain. METHODS We conducted a retrospective cohort study of children seen in the emergency department of Children's Hospital Boston who had CSF obtained between December 1992 and September 2005. Patients who had ventricular shunts, as well as those who received antibiotics before CSF was obtained were excluded. Test characteristics of CSF Gram stain were assessed using CSF culture as the criterion standard. Patients were considered to have bacterial meningitis if there was either: (1) growth of a pathogen, or (2) growth of a possible pathogen noted on the final CSF culture report and the patient was treated with a course of parenteral antibiotics for 7 days or more without other indication. RESULTS A total of 17,569 eligible CSF specimens were collected among 16,036 patients during the 13-year study period. The median age of study subjects was 74 days. Seventy CSF specimens (0.4%) had organisms detected on Gram stain. The overall sensitivity of Gram stain to detect bacterial meningitis was 67% [42 of 63; 95% confidence interval (CI): 54-78] with a positive predictive value of 60% (42 of 70; 95% CI: 48-71). Most patients without bacterial meningitis have negative Gram stain [specificity 99.9% (17,478 of 17,506; 95% CI: 99.8-99.9)] with a negative predictive value of 99.9 (17,478 of 17,499; 95% CI: 99.8-99.9). CONCLUSIONS CSF Gram stain is appropriately used by physicians in risk stratification for the diagnosis and empiric treatment of bacterial meningitis in children. Although a positive Gram stain result greatly increases the likelihood of bacterial meningitis; the result may be because of contamination or misinterpretation in 40% of cases and should not, by itself, result in a full treatment course for bacterial meningitis.
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Cho SY, Kim TY, Lee H, Kim KH, Yoo ES, Kim HS, Park EA, Ryu KH, Seo JW, Sohn S, Lee SJ. Bacterial meningitis in children experienced at a university hospital, 1993-2006. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.10.1077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sung Yoon Cho
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae Yeon Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyunju Lee
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyung Hyo Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Sun Yoo
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hae Soon Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyung Ha Ryu
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jeong Wan Seo
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung Joo Lee
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
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25
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Pneumococcal meningitis in the era of pneumococcal conjugate vaccine implementation. Eur J Clin Microbiol Infect Dis 2007; 27:191-9. [DOI: 10.1007/s10096-007-0417-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
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26
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Lee YJ, Lee SJ, Park HJ, Lee YH, Kang SY, Kim YC, Lee IK, Lee KY, Lee KS, Kim WS. A clinical study of child bacterial meningitis in Daejeon and Chungcheong area: 2001-2005. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.2.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yong Joo Lee
- Department of Pediatrics, Eulji University School of Medicine, Cheonan, Korea
| | - Soo Jin Lee
- Department of Pediatrics, Eulji University School of Medicine, Cheonan, Korea
| | - Ho Jin Park
- Department of Pediatrics, Eulji University School of Medicine, Cheonan, Korea
| | - Young Hyuk Lee
- Department of Pediatrics, Konyang University College of Medicine, Cheonan, Korea
| | - So Young Kang
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Young Chang Kim
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - In Kyu Lee
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kyung Yeon Lee
- Department of Pediatrics, The Gatholic University College of Medicine, Chongju, Korea
| | - Keon Su Lee
- Department of Pediatrics, Chungnam National University College of Medicine, Korea
| | - Won Seop Kim
- Department of Pediatrics, Chungbuk National University College of Medicine, Korea
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Miranzi SDSC, Moraes SAD, Freitas ICMD. Tendência das meningites por Haemophilus influenzae tipo b no Brasil, em menores de 5 anos, no período de 1983 a 2002. Rev Soc Bras Med Trop 2006; 39:473-7. [PMID: 17160326 DOI: 10.1590/s0037-86822006000500010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 09/08/2006] [Indexed: 11/22/2022] Open
Abstract
Trata-se de um estudo ecológico, tipo série histórica (1983-2002), onde foram calculados os coeficientes de incidência, mortalidade e letalidade de meningites por Haemophilus influenzae , tipo b, no Brasil, e avaliou-se a tendência da morbi-mortalidade em menores de 5 anos. Para a análise de tendência dos coeficientes construíram-se modelos de regressão polinomial para as faixas etárias de < 1 ano e de 1 a 4 anos. O nível de significância adotado foi alfa=0,05. 43,9% dos casos confirmados ocorreram em menores de 1 ano e 38,7% nos de 1 a 4 anos. Os indicadores de maior magnitude também foram observados nestas duas faixas etárias. Desde o início da série, houve uma tendência de ascensão dos coeficientes de incidência e mortalidade até, aproximadamente, 1999, quando foi observado declínio abrupto destes indicadores. Os resultados reforçam a eficiência do Programa de Vacinação contra HIB, no Brasil, que favoreceu, inclusive, faixas etárias não vacinadas (Imunidade Rebanho).
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Kim HS, Kim HR. Comparison of hypertonic saline treatment in meningitis with cerebral edema. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.12.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hyung Su Kim
- Department of Pediatrics, Busan Medical Center, Korea
| | - Hee Ra Kim
- Department of Pediatrics, Busan Medical Center, Korea
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29
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Bingen E, Levy C, de la Rocque F, Boucherat M, Varon E, Alonso JM, Dabernat H, Reinert P, Aujard Y, Cohen R. Bacterial meningitis in children: a French prospective study. Clin Infect Dis 2005; 41:1059-63. [PMID: 16142676 DOI: 10.1086/432944] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Accepted: 06/01/2005] [Indexed: 11/03/2022] Open
Abstract
From January 2001 through December 2003, a total of 1084 children with bacterial meningitis were enrolled in a prospective French nationwide survey. The most frequent pathogens found in children older than 28 days were Neisseria meningitis (55.3%) and Streptococcus pneumoniae (33.4%). S. pneumoniae was the most frequent pathogen found among infants aged 2-12 months (49.5%), whereas N. meningitidis was the most frequent pathogen among children >12 months old (69.7%). Approximately one-half of S. pneumoniae isolates had diminished susceptibility to penicillin. The case-fatality rates were 7.6% for children with N. meningitidis meningitis and 10.8% for children with S. pneumoniae infection.
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Affiliation(s)
- Edouard Bingen
- Service de Microbiologie EA3105, Hôpital Robert Debré, Paris, France.
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30
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Bingen E, Lévy C, De la Rocque F, Boucherat M, Aujard Y, Cohen R. Méningites à pneumocoque de l'enfant en France : âge de survenue et facteurs de risques médicaux. Arch Pediatr 2005; 12:1187-9. [PMID: 15908187 DOI: 10.1016/j.arcped.2005.04.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Streptococcus pneumoniae (Sp) is an important cause of morbidity and mortality among paediatric infectious diseases. The aim of this study is to analyse specific data on Sp meningitis out of the Bacterial Meningitis (BM) French Surveillance Network about mean age of BM cases and clinical features. Overall 367 Sp BM were reported between January 2001 to January 2004 (sex ratio M/F: 1.3), 69.7% were < 2 years old, median age 0.8 year (minmax 0-16.8 years). Before two years old children, 94.1% had no medical risk factor and no underlying conditions: on the other hand, after two years old, these factors were reported in 27% cases (P < 0.001). Mortality rate was 10.9%. On account of a Sp BM's pic at five months, data of the BM French Surveillance Network confirm the necessity of an early vaccination. The vaccine administration at two, three, four months with a booster during the second year, recommended in the vaccinal french calendar, seems particularly adapted to the Sp BM in France.
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Affiliation(s)
- E Bingen
- Groupe de pathologie infectieuse pédiatrique (GPIP) de la Société française de pédiatrie (SFP), service de microbiologie, hôpital Robert-Debré, Paris, France.
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Abstract
Microbiologic causes of meningitis include bacteria, viruses, fungi, and parasites. Before routine use of pneumococcal conjugate vaccine, bacterial meningitis affected almost 6000 people every year in the United States, and about half of all cases occurred in children 18 years old or younger. Prompt and accurate diagnosis and adequate treatment of bacterial meningitis in children remains a major challenge, as reflected by the continued high morbidity and case-fatality rates of the disease worldwide. Appropriate use of antibiotics, along with adjunctive therapies, such dexamethasone, has proved helpful in the prevention of neurologic sequelae in children with bacterial meningitis. Better understanding of pathophysiologic mechanisms likely would result in more effective therapies in the future.
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Affiliation(s)
- Susana Chávez-Bueno
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
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McIntyre PB, Macintyre CR, Gilmour R, Wang H. A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis. Arch Dis Child 2005; 90:391-6. [PMID: 15781931 PMCID: PMC1720332 DOI: 10.1136/adc.2003.037523] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite an extensive literature, the impact of both adjunctive steroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis is controversial. AIM To determine the independent contribution of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis in a representative population with good access to medical services. METHODS Data were obtained from laboratories and hospital records to assemble a population register in Sydney, Australia, 1994-99. Follow up questionnaires were completed by attending physicians. RESULTS A total of 122 cases of pneumococcal meningitis aged 0-14 years were identified. Almost 50% of 120 children with available records either died (n = 15) or had permanent neurological impairment (n = 39). Early use (before or with parenteral antibiotics) of corticosteroids protected against death or severe morbidity (adjusted OR 0.21, 95% CI 0.05 to 0.77). Delayed diagnosis was associated with increased morbidity in survivors (OR 3.4, 95% CI 1.03 to 11.4) but not with increased mortality. CONCLUSION In a population with good access to health care and after adjusting for other known prognostic variables, early recognition of pneumococcal meningitis and treatment with adjunctive dexamethasone significantly improves outcomes. These data add to those from randomised controlled trials. Implementation requires development of protocols and guidelines for use in emergency departments.
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Affiliation(s)
- P B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, NSW, Australia
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Chang CJ, Chang WN, Huang LT, Huang SC, Chang YC, Hung PL, Lu CH, Chang CS, Cheng BC, Lee PY, Wang KW, Chang HW. Bacterial meningitis in infants: the epidemiology, clinical features, and prognostic factors. Brain Dev 2004; 26:168-75. [PMID: 15030905 DOI: 10.1016/s0387-7604(03)00122-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2003] [Revised: 06/02/2003] [Accepted: 06/09/2003] [Indexed: 11/17/2022]
Abstract
This 16-year (1986-2001) retrospective study enrolled 80 infantile patients (aged, 30-365 days old) with culture-proven bacterial meningitis. The most prevalent pathogens were Salmonellaspecies, Streptococcus (S.) agalactiae, Escherichia (E.) coli, and Haemophilus (H.) influenzae, accounting for about 59% of the episodes. Meningitis caused by Salmonella species, E. coli and H. influenzae occurs more often in the older infants, while that caused by S. agalactiae occurs more often in young infants. Our study revealed a decrease in the proportion of Salmonella meningitis from 27% in the first 8 years to 9% in the second 8 years with E. coli replacing Salmonella species as the leading pathogen of this disease during the second period. Overall mortality rate for both periods of time was 11%. However, if we take those with undesirable poor outcomes into account, 43% of patients could be considered treatment failures. The study also reveals a high prevalence of neurological complications when this disease is caused by H. influenzae, S. pneumoniae, and Salmonella species. Stepwise logistic regression analysis revealed that only initial changing levels of consciousness (P = 0.006) were independently associated with treatment failure. The most frequent neurological complications associated with this disease included subdural empyema, hydrocephalus, cerebral infarctions, and seizures. Because therapeutic regimens may require attention to the eradication of bacterial pathogen but also the neurological complications, early diagnosis and choice of appropriate antibiotics are essential to increasing the possibility of survival.
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Affiliation(s)
- Chin-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital-Jiayi, Jiayi, Taiwan
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Abstract
This review comprises aspects of the epidemiology, microbiology, pathophysiology, clinical manifestations, diagnosis, management, prognosis, and prevention of bacterial meningitis, with emphasis on the paediatric population. The beginning of this millennium has witnessed the virtual disappearance of Haemophilus invasive disease in some countries, emergence of pneumococcal strains that are resistant to multiple antibiotics, isolation of pneumococci with tolerance to vancomycin, outbreaks and clusters of meningococcal meningitis in several geographical areas, and intense research in development of effective conjugate pneumococcal and meningococcal vaccines. Bacterial meningitis has become an uncommon disease in the developed world. Unfortunately, because of limited economic resources and poor living conditions, many developing countries are still affected by the devastating consequences of this life-threatening systemic infection. Basic and clinical research is needed to discover new antimicrobial and anti-inflammatory agents to improve outcome from disease. Novel strategies are needed to distribute and implement effective vaccines worldwide to prevent bacterial meningitis.
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Affiliation(s)
- Xavier Sáez-Llorens
- University of Panama School of Medicine, Hospital del Niño, Panama City, Panama.
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