ABSTRACT
During a 14-month period, 77 children (excluding neonates) with bacterial meningitis were studied. The causative organisms were identified in 60 children: Haemophilus influenzae in 26 (34%), Streptococcus pneumoniae in 20 (26%), Gram-negative enteric bacilli in nine (12%) and beta-haemolytic streptococci group A in one. No organism was identified in 17 (22%) cases. The male to female ratio was 1.2:1. The age group most affected was between 2 and 12 months. The case mortality rate was 13% and nine children (12%) were left with permanent neurological sequelae.
Subject(s)
Meningitis, Bacterial/etiology , Child , Child, Preschool , Enterobacteriaceae/isolation & purification , Female , Follow-Up Studies , Haemophilus influenzae/isolation & purification , Humans , Infant , Libya , Male , Meningitis, Bacterial/blood , Meningitis, Bacterial/cerebrospinal fluid , Prospective Studies , Streptococcus pneumoniae/isolation & purification , Streptococcus pyogenes/isolation & purificationABSTRACT
This study characterised the levels of serum immunoglobulin G (IgG), cerebrospinal fluid IgG (CSF IgG) and IgG index as an aid to the diagnosis and prognosis of acute bacterial meningitis (ABM). A total of 28 patients with proven ABM at admission (age range: one month to 10 years; 17 males, 11 females) (group A) and 17 age- and sex-matched control children (group B) were studied. Levels were also compared between patients with neurological morbidity (n = 4; group C) and without neurological morbidity (n = 24; group D) who were subsets of group A. In addition, patients were divided randomly into two groups based on the treatment received (i.e. ceftriaxone together with dexamethasone [n = 11; group A1] and ceftriaxone only [n = 9; group A2] to assess the effect of dexamethasone. The results (mean +/- SEM) demonstrated intrathecal synthesis of IgG in ABM (group A vs group B: CSF IgG (mg/L): 92.64 +/- 23.54 vs 2.12 +/- 1.08, P < 0.002; IgG index: 0.959 +/- 0.481 vs 0.029 +/- 0.006, P < 0.001) which showed good diagnostic significance. In the patients with permanent neurological morbidity (group C) vs healthy survivors (group D), the CSF IgG and IgG index showed good prognostic significance (group C vs group D: CSF IgG (mg/L): 10.75 +/- 9.75 vs 106.24 +/- 29.37, P < 0.01; IgG index: 0.046 +/- 0.039 vs 1.132 +/- 0.568, P < 0.05). Dexamethasone lowered CSF-IgG and IgG-index levels, but the effect was not statistically significant (group A1 vs group A2: P > 0.1).
Subject(s)
Immunoglobulin G/analysis , Meningitis, Bacterial/diagnosis , Acute Disease , Anti-Inflammatory Agents/therapeutic use , Child , Child, Preschool , Dexamethasone/therapeutic use , Female , Glucocorticoids/therapeutic use , Humans , Infant , Male , Meningitis, Bacterial/drug therapyABSTRACT
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.
Subject(s)
Ceftriaxone/administration & dosage , Cephalosporins/administration & dosage , Dexamethasone/therapeutic use , Glucocorticoids/therapeutic use , Meningitis, Bacterial/drug therapy , Child , Child, Preschool , Drug Therapy, Combination , Female , Humans , Infant , Libya/epidemiology , Male , Meningitis, Bacterial/complications , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/mortalityABSTRACT
Ceftriaxone (RO 13-9904) has only recently been introduced in Benghazi and many parts of the word. We determined its in-vitro antibacterial activity against the primary aetiological agents of childhood meningitis in Benghazi, that included eighteen (23.3%) strains of H. influenzae, 17 (22.1%) of Str. pneumoniae and 1 (1.3%) of N. meningitidis isolated from 77 cases of acute purulent meningitis above the age of neonatal period. All strains of H. influenzae. Str. pneumoniae and N. meningitidis were sensitive to ceftriaxone and showed wide zones of inhibition by the disc diffusion technique of Kirby-Bauer. Ampicillin and chloramphenicol resistance was observed for H. influenzae (23% and 11% respectively), and Str. pneumoniae (12% and 0% respectively), in addition, 18% of strains of Str. pneumoniae showed resistance to penicillin. The broad spectrum activity of ceftriaxone has been confirmed for our locality and this finding, together with its exceptionally long half-life, excellent penetration into the C.S.F. and ease of administration (single daily dose) warrants it as the drug of choice in empherical treatment of cases of acute bacterial meningitis in children in Benghazi and in cases where resistance to ampicillin and chloramphenicol are found on subsequent testing.
Subject(s)
Anti-Bacterial Agents/pharmacology , Ceftriaxone/pharmacology , Cephalosporins/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Meningitis, Bacterial/drug therapy , Acute Disease , Child , Child, Preschool , Female , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Humans , Infant , Libya , Male , Meningitis, Bacterial/microbiology , Microbial Sensitivity Tests , Sensitivity and SpecificityABSTRACT
Resistotyping of P. mirabilis using 10 compounds is reported. The method was tested for reproducibility and specificity and results were compared with those obtained by serological, bacteriophage, and proticine typing methods and the Dienes test. The possible relationship between resistance to the chemicals used in the test and antibiotics was also studied.The method was found to be simple, reproducible, show good specificity, and compare favourably with other typing methods. No linkage between resistance to the chemicals and antibiotic resistance was detected.
