The burden of pneumococcal meningitis in Austrian children between 2001 and 2008.

UNLABELLED: The present study was conducted to evaluate the burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Clinical outcome was retrospectively analyzed both on discharge and on follow-up investigations. This study was based on a prospective multicentre surveillance study on hospitalized invasive pneumococcal infections in Austrian children with a total annual "study population" of about 399,000 children aged below 5 years per year. Between 2001 and 2008, 74 cases of pneumococcal meningitis were identified in children aged below 5 years. The mean annual incidence rate for pneumococcal meningitis was 2.3 per 100,000 children in this age group. In 57/74 children (mean age on admission 14.5 ± 13.3 months), outcome data on hospital discharge were available: 5 deaths (8.8%), 20 children (35.1%) with sequelae and 32 children (56.1%) without sequelae were observed. Sequelae on discharge included motor impairment in 8 children (14.0%), hearing impairment in 9 children (15.8%) and/or other complications in 14 children (24.6%). In 7/8 children with motor deficits, matching cerebral lesions were identified by neuroimaging: cerebral infarction in five children, cerebral vasculitis and cerebral abscess in one child each. In 40/57 children, long-term outcome (18.9 ± 20.2 months after discharge) could be assessed: 1 child (2.5%) died 9 months after hospital discharge, 11 children (27.5%) had one or two long-term sequelae and 28 children (70.0%) had no sequelae. Long-term sequelae included motor impairment in three children (7.5%), hearing impairment in nine children (22.5%) and other deficits in two children (5.0%). CONCLUSION: Our study confirms that pneumococcal meningitis causes high mortality and severe long-term sequelae. On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment.

[Ophthalmia neonatorum]. / Ophthalmia neonatorum.

Silver nitrate prophylaxis against ophthalmia neonatorum due to Neissera Gonorrhoeae was introduced by Crédé in 1884, when he instilled a drop of 2% silver nitrate into the cul-de-sac of a newborn. Today, the prime cause of ophthalmia neonatorum is infection by Chlamydia trachomatis. The high incidence of this type of conjunctivitis is due to the frequent exposure of the newborn during delivery and to the ineffectiveness of silver nitrate as a prophylaxis against Chlamydia. In the study reported here, 198 infants less than one month old were examined because of severe bilateral conjunctivitis. In the first week of life a chemical irritation caused by Crédé's prophylaxis was found in the majority (59.7%), but in the second and third weeks infections with Chlamydia trachomatis were found in 27% of all cases. Bacteria were responsible for the infection in 52% of the cases. No gonococci were found in any of the patients examined in the course of the study.