ABSTRACT
The relationship of presentation to outcome in children with meningitis was analysed. The relative risk (95% confidence interval) of an adverse outcome (death or neurological sequelae) associated with presentation with at least three of ten features (age < or = 2 yrs, ill for > 7 days, antibiotic treatment, focal nerve deficits, abnormal posturing, abnormal muscle tone, lack of typical meningeal signs, shock, unrousable coma and seizures) was 4.9 (2.7, 8.8), p < 0.0001. The first six features were particularly associated with neurological sequelae, and shock and coma with death. Seizures were associated with either outcome. Two seizure types could be distinguished: seizures which occurred before or on diagnosis only (type I seizures) and seizures which occurred before and/or after diagnosis (type II seizures). Death occurred in 0/41 children without seizures and in 14/34 and 11/34 children with type I and type II seizures, respectively (p < 0.0001). Neurological sequelae occurred in 3/42 children without seizures and in 5/20 and 14/23 with type I and type II seizures, respectively (p < 0.0001).
Subject(s)
Developing Countries , Meningitis, Bacterial/complications , Seizures/microbiology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis, Bacterial/diagnosis , Nigeria , Prognosis , Prospective Studies , Retrospective Studies , Risk Factors , Severity of Illness Index , Tropical ClimateABSTRACT
Gram negative bacillary meningitis (GNBM) in postneonatal infants and children is two to three times more common in developed compared to developing countries. Other major differences are in the pattern of pathogens (mainly Klebsiella spp and Salmonella spp in developing versus E. coli in developed countries) and associated conditions (diarrhoeal diseases and malnutrition in developing versus neurosurgical and urinary tract abnormalities in developed countries). 12 (11.5%) of 104 cases of bacterial meningitis were due to GNB, including Klebsiella spp seven, E. coli, two and untyped Coliform spp, three; the age range of patients with GNBM was 3-24 months. Among seven completely evaluable patients, six presented after seven days of illness, five convulsed on or before admission, and six had accompanying respiratory or gastro-enteritic illnesses but none was severely malnourished or had associated neurosurgical or urinary tract abnormalities. Three patients died, three were discharged with sequelae and one without sequelae. The only significant difference between patients with GNBM and those with meningitis due to "usual" pathogens was the greater tendency to delayed presentation among the former (6/7 patients with GNBM versus 11/36 "usual" pathogens; p = 0.011); this was also the only striking difference in presentation when compared with patients from developed countries. The need for further studies, preferably multicentred, and for a revision of the traditional combination of gentamicin and ampicillin or chloramphenicol and ampicillin for the treatment of GNBM in developing countries is discussed.
Subject(s)
Developing Countries , Gram-Negative Bacterial Infections/epidemiology , Meningitis, Bacterial/epidemiology , Adolescent , Age Distribution , Child , Child, Preschool , Developed Countries , Drug Resistance, Microbial , Gram-Negative Bacterial Infections/microbiology , Humans , Infant , Infant, Newborn , Meningitis, Bacterial/microbiology , Microbial Sensitivity Tests , Nigeria/epidemiology , Population SurveillanceABSTRACT
The case of a 2 month old Nigerian girl with right-sided pulmonary aplasia and extra-pulmonary anomalies is presented. The early demise of the patient is attributable to the apprarent dextrocardia; repeated bronchopneumonia of the sole lung and failure to institute continuous antibiotic therapy. The difficulty in differentiating between pulmonary aplasia; agenesis and hypoplasia is highlighted
