DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20183261

Clinical profile and outcome of pediatric bacterial meningitis: a prospective study from tertiary institute in Northern India

Ashok Garg, Ashish Sharma, Sandhya Kumari, Ambuj Shandil

Abstract


Background: Meningitis is one of the fatal infections occurring in infants and older children. In acute bacterial meningitis (ABM), inflammation of the leptomeninges is triggered by bacteria present in the subarachnoid space. ABM is associated with a high rate of acute complications and long-term morbidity. Aim of our study was to determine the incidence, etiological profile and complications of acute bacterial meningitis amongst children belonging to one month to five years of age.

Methods: The present study was conducted over a period of one year and diagnosis of meningitis was made on basis of history, examination and laboratory investigations. Clinical features were recorded on case sheet. Lumbar puncture was done, and CSF was sent for biochemical analysis, cell counts, staining, culture and latex agglutination test (LAT).

Results: Out of total 1560 admitted cases (1 month to 5years age group), 160 cases were suspected with meningitis while 57 cases were confirmed to have ABM. Most (59.6%) cases belonged to 3 months to 1-year age group and males outnumbered the females by a ratio of 2:1. Group B Streptococcus (45.6%) was most common pathogen in 45.6% cases followed by Streptococcus pneumoniae (21%) and Hemophilus influenzae (10.52%). Seizures (45%) and increased ICP (28%) were main acute complications observed during hospitalization while hemiparesis 9.6%, monoparesis 4.8%, seizures 38%, vision and hearing deficits were the sequelae observed on follow up examination. These complications were predominantly contributed by S. pneumoniae and H. Influenzae.

Conclusions: The incidence of ABM is still high and Group B streptococcus is main pathogen even in post neonatal period. The complications of ABM are markedly higher in cases of S. pneumoniae, H. Influenzae meningitis in comparison to Group B streptococcus meningitis. Formulating standard protocols for management of ABM and rational antibiotic use to prevent resistance is the need of hour.


Keywords


Bacterial, Complications, Hemophilus, Meningitis

Full Text:

PDF

References


Tauber MG, Schaad UB. Bacterial infection of nervous system. In: Swaiman KF, Ashwal S, Ferriero DM (eds). Pediatric neurology principles and practice. 4th ed. USA: Elsevier;2008:1571.

Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A, et al. Diagnosis outcome of acute bacterial meningitis in early childhood. Indian Pediatr. 2002;39:914-921.

Singhi P, Bansal A, Geeta P, Singhi S. Predictors of long term neurological outcome in bacterial meningitis. Indian J Pediatr. 2007:74(4); 369-74.

Tsai CJ, Griffin MR, Nuorti JP, and Grijalva CJ. Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis. 2008;46(11):1664-72.

George CN, Letha S, Bai SS. A clinical study of chronic morbidity in children following pyogenic meningitis. Indian Pediatr. 2002;39:663-7.

Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis. 2010;10:32-42.

Weisefelt, vande Beek D, Spanjard L, Reitsma JB, Gans JD. Clinical features, complications and outcome in meningitis: a prospective case series. Lancet Neurol. 2006;5:123-129.

Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267-84.

Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DGA. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgrad Med J. 2010;86:478-85.

Cherian T. Current concepts in the pathogenesis, pathophysiology and management of bacterial meningitis. Pediatrics Today. 2000;3:268-72.

Prober CG. Central nervous system infections. In: Kliegman RM, Stanton BF, Gene JWS, Schor NF (eds). Nelson textbook of pediatrics. 19th ed. USA: Elsevier;2012:2086-2098.

Ogunlesi TA, Okeniyi JAO, Oyelami OA. Pyogenic meningitis in Ilesa Osun State Nigeria. Ind Pedia. 2005;42:1019-23.

Kabra SK, Kumar P, Verma IC, Mukherjee D, Chowdhary BH, Sengupta S, et al. Bacterial meningitis in India: An IJP survey. Ind J Pediatr. 1991 Jul 1;58(4):505-11.

Mani R, Pradhan S, Nagrathna S, Wasiulla R, Chandermukhi A. Bacteriological profile of community acquired acute bacterial meningitis: a ten year retrospective study in a tertiary neurocare centre in south India. Ind J Med Microbiol. 2007;25(2):108-14.

Dash N, Panigrahi D, Khusaiby SA, Awaidy SA, Bawikar S. Acute bacterial meningitis among children <5 years of age in Oman: a retrospective study during 2000-2005 J Infect Developing Countries. 2008;2(2):112-5.

Deivanayaganam N, Ashok TP, Nedunchelian K, Ahmed SS, Mala N. Bacterial meningitis: Diagnosis by latex agglutination test and clinical feature. Indian Pediatr. 1993;30:495-500.

Mohammadi SF, Patil AB, Nadagir SD, Nandihal N, Lakshminarayana S A. Diagnostic value of latex agglutination test in diagnosis of acute bacterial meningitis. Ann Ind Aca Neurol. 2013;16:645-9.

Debnath DJ, Wanjpe A, Kakrani V, Singru S. Epidemiological study of acute bacterial meningitis in admitted children below twelve years of age in a tertiary teaching hospital in Pune, India. M J DY Patil Uni. 2012;5:28-30.

Bhat BV, Verma IC, Puri RK, Srinivasan S, Nalini P. A profile of pyogenic meningitis in children. J Indian Med Assoc. 1991;89:224-7.

Surinder K, Bineeta K, Megha M. Latex particle agglutination test as an adjunct to the diagnosis of bacterial meningitis. IJMM. 2007;25(4):395-97.

Das BK, Gurubacharya RL, Mohapatra TM, Mishra OP. Bacterial antigen detection test in meningitis. Indian J Pediatr. 2003;70(10):799-801.

Florindo C, Gomes JP, Rato MG, Bernardino L, Spellerberg B, Santos-Sanches I, et al. Molecular epidemiology of group B streptococcal meningitis in children beyond the neonatal period from Angola. J Med Microbiol. 2011 Sep 1;60(9):1276-80.

Dwivedi S, Das BK, Aneja S, Sharma S, Chaturvedi MK, Kahn G, et al. Group B streptococcal meningitis in infants beyond the neonatal period. Ind J Pediatr. 2014 Jan 1;81(1):4-8.

Baker CJ, Rench MA. Commercial latex agglutination for detection of group B streptococcal antigen in body fluids. J Pediatr. 1983;102:393-5.

Goetghebuer T, West TE, Wermenbol V, Cadbury AL, Milligan P, Lloyd‐Evans N, et al. Outcome of meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae type b in children in The Gambia. Trop Med Inter Heal. 2000 Mar;5(3):207-13.

Fortnum HM, Devis AC. Epidemiology of bacterial meningitis. Arch Dis Child. 1993;68:763-7.

Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J. 1993;12:389-94.

Grimwood K, Anderson P, Anderson V, Tan L, Nolan T. Twelve year outcomes following bacterial meningitis: further evidence for persisting effects. Arch Dis Child. 2000; 83:111-6.

Halket S, de Louvois J, Holt DE, Harvey D. Long term follow up after meningitis in infancy: behaviour of teenagers. Arch Dis Child. 2003;88:395-8.

Bedford H, de Louvois J, Halket S, Peckham C, Hurley R, Harvey D. Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ. 2001;323:533-6.

Oostenbrink R, Maas M, Moons KG, Moll HA. Sequelae after bacterial meningitis in childhood. Scand J Infect Dis. 2002;34:379-82.