Prognosis of bacterial meningitis in children

Gomes, Irenio; Melo, Ailton; Lucena, Rita; Cunha-Nascimento, Marco Heleno; Ferreira, Adriana; Góes, Julieta; Barreto, Ismara; Jones, Neila; Gaspari, Verônica; Embiruçu, Emilia Katiane; Veiga, Marielza

doi:10.1590/S0004-282X1996000300008

Abstracts

We studied the incidence and prognosis of acute neurologic complications in 281 children under 13 years of age with a diagnosis of acute bacterial meningitis. All the patients were examined daily by the same group of neurologists, using a standardized neurological examination. Patients with signs of encephalic lesions, unsatisfactory response to antibiotics or decreased level of consciousness were submitted to brain computer tomography. The overall lethality rate was 20.3% and cases whose causative agent was identified presented a higher lethality rate (23.7%) than those in which the agent was not found. The most important neurological abnormalities were meningeal signs (88.3%) followed by decreased consciousness (47.7%), irritability (35.2%), seizures (22.4%), fontanel bulging (20.6%) and cranial nerve palsy (14.2%). Seizures, cranial nerve palsy and the absence of meningeal signs were related to higher rates of lethality. Diminished consciousness, seizures, subdural effusion, abscess and hydrocephalus were the most important complications, respectively. We can conclude that acute bacterial meningitis continues to be an important health problem in developing countries and that public health measures will be necessary to minimize the impact of sequelae and reduce the mortality rate in children with that pathology.

pyogenic meningitis; bacterial meningitis; septicemia; meningitis in children

Para estudar os fatores prognósticos e incidência de complicações em meningite bacteriana, 281 crianças (idade abaixo de 13 anos) com quadro clínico e do LCR compatíveis com esse diagnóstico foram acompanhadas, durante o internamente), através de ficha de avaliação padrão. Aquelas que apresentaram sinais de lesão encefálica, resposta inadequada ao tratamento ou diminuição do nível de consciência, com Glasgow < 7, foram submetidas a tomografia computadorizada de crânio. A taxa de letalidade global foi 20,3%, sendo maior quando o agente etiológico foi identificado (23,7%). As alterações neurológicas mais encontradas foram: irritação meníngea, diminuição do nível de consciência, convulsões, irritabilidade, abaulamento de fontanela e comprometimento de nervos cranianos. Convulsões, comprometimento de nervos cranianos e ausência de irritação meníngea foram associados a maior Ietalidade. Complicações neurológicas ocorreram em 58%, sendo as mais frequentes diminuição do nível de consciência (47,7%), convulsões (22,4%), coleção subdural (3,2%), abscesso(2,5%) e hidrocefalia(2,5%). Observamos que meningite bacteriana continua sendo problema de saúde publica em países em desenvolvimento e que medidas para redução da morbidade e mortalidade desta doença são necessárias.

meningite piogênica; meningite bacteriana; septicemia; meningite em crianças

Prognosis of bacterial meningitis in children

Prognóstico de meningite bacteriana em crianças

Irenio Gomes^I; Ailton Melo^II; Rita Lucena^III; Marco Heleno Cunha-Nascimento^IV; Adriana Ferreira^IV; Julieta Góes^IV; Ismara Barreto^IV; Neila Jones^IV; Verônica Gaspari^IV; Emilia Katiane Embiruçu^IV; Marielza Veiga^I

^IHospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador. Docente do Serviço de Neurologia

^IIHospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador. Chefe do Serviço de Neurologia

^IIIHospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador. Pós-graduanda de Neuropsicofarmacologia

^IVHospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador. Estagiário do Serviço de Neurologia

ABSTRACT

We studied the incidence and prognosis of acute neurologic complications in 281 children under 13 years of age with a diagnosis of acute bacterial meningitis. All the patients were examined daily by the same group of neurologists, using a standardized neurological examination. Patients with signs of encephalic lesions, unsatisfactory response to antibiotics or decreased level of consciousness were submitted to brain computer tomography. The overall lethality rate was 20.3% and cases whose causative agent was identified presented a higher lethality rate (23.7%) than those in which the agent was not found. The most important neurological abnormalities were meningeal signs (88.3%) followed by decreased consciousness (47.7%), irritability (35.2%), seizures (22.4%), fontanel bulging (20.6%) and cranial nerve palsy (14.2%). Seizures, cranial nerve palsy and the absence of meningeal signs were related to higher rates of lethality. Diminished consciousness, seizures, subdural effusion, abscess and hydrocephalus were the most important complications, respectively. We can conclude that acute bacterial meningitis continues to be an important health problem in developing countries and that public health measures will be necessary to minimize the impact of sequelae and reduce the mortality rate in children with that pathology.

Key words: pyogenic meningitis, bacterial meningitis, septicemia, meningitis in children.

RESUMO

Para estudar os fatores prognósticos e incidência de complicações em meningite bacteriana, 281 crianças (idade abaixo de 13 anos) com quadro clínico e do LCR compatíveis com esse diagnóstico foram acompanhadas, durante o internamente), através de ficha de avaliação padrão. Aquelas que apresentaram sinais de lesão encefálica, resposta inadequada ao tratamento ou diminuição do nível de consciência, com Glasgow < 7, foram submetidas a tomografia computadorizada de crânio. A taxa de letalidade global foi 20,3%, sendo maior quando o agente etiológico foi identificado (23,7%). As alterações neurológicas mais encontradas foram: irritação meníngea, diminuição do nível de consciência, convulsões, irritabilidade, abaulamento de fontanela e comprometimento de nervos cranianos. Convulsões, comprometimento de nervos cranianos e ausência de irritação meníngea foram associados a maior Ietalidade. Complicações neurológicas ocorreram em 58%, sendo as mais frequentes diminuição do nível de consciência (47,7%), convulsões (22,4%), coleção subdural (3,2%), abscesso(2,5%) e hidrocefalia(2,5%). Observamos que meningite bacteriana continua sendo problema de saúde publica em países em desenvolvimento e que medidas para redução da morbidade e mortalidade desta doença são necessárias.

Palavras-chave: meningite piogênica, meningite bacteriana, septicemia, meningite em crianças.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 11-abril-1996.

This paper was partially presented at the Fifth Meeting of the European Neurological Society.

Dr. Ailton Melo - Faculdade de Medicina UFBA - Av. Reitor Miguel Calmon, s/n - 40110-100 Salvador BA -Brasil. FAX 5571 3580592.

References

1. Bryan JP, Silva HR, Tavares A, Rocha H, Scheld WM. Etiology and mortality of bacterial meningitis in Northeastern Brazil. Rev Inf Dis 1990;12:128-135.
2. Cadoz M, Denis F, Diop Mar I. Etude épidémiologique des cas de méningites purulentes hospitalises à Dakar pendant la décennie 1970-79. Bull Organis Mond Santé 1981;59:575-584.
3. Ferreira A, Nascimento MHC, Gomes 1, Melo A. Neurologic complications in bacterial meningitis. J Neurol 1995;242:(Suppl):S-115.
4. Geiman BJ, Smith AL. Dexamethasone and bacterial meningitis: a metanalysis of randomized controllled trials. West J Med 1992;157:27-31.
5. Girgis NI, Farid Z, Mikhail IA, Ferrag I, Sultan Y, Kilpatrick ME. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989;8:848-851.
6. Herson VC, Todd JK. Prediction of morbidity in H. influenzae meningitis. Pediatrics 1977;59:35-39.
7. Lebel MH, Freij BJ, Syrogiannopoulos GA et al. Dexamethasone therapy for bacterial meningitis: results of two double blind placebo controlled trials. N Engl J Med 1988;319:964-971.
8. Odio CM, Faingezcht I, Paris M et al. The beneficial effects of early dexametasone administration in infants and children with bacterial meningitis. N Eng J Med 1991 ;324:1525-1531.
9. Pfister HW, Borasie GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology 1992;42:1497-1504.
10. PfisterHW, Feiden W, Einhaupl KM. Spectrum of complications during bacterial meningitis in adults: results of a prospective clinical study. Arch Neurol 1993;50:575-581.
11. Quagliarello V, Scheld WM. Bacterial meningitis: pathogenesis, pathophysiology and progress. N Engl J Med 1992;327:864-872.
12. Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad based epidemiologic study. Medicine 1987;66:148-156.
13. Spanos A, Harrel FE, Durack DT. Differential diagnosis of acute meningitis: an analysis of the predictive value of initial observations. JAMA 1989;2700-2707.
14. Tunkel AR, Wispelwey B, Scheld M. Bacterial meningitis: recent advances in pathophysiology and treatment. Ann Intern Med 1990;112:610-623.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
Sept 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bryan JP, Silva HR, Tavares A, Rocha H, Scheld WM. Etiology and mortality of bacterial meningitis in Northeastern Brazil. Rev Inf Dis 1990;12:128-135.

[2] 2. Cadoz M, Denis F, Diop Mar I. Etude épidémiologique des cas de méningites purulentes hospitalises à Dakar pendant la décennie 1970-79. Bull Organis Mond Santé 1981;59:575-584.

[3] 3. Ferreira A, Nascimento MHC, Gomes 1, Melo A. Neurologic complications in bacterial meningitis. J Neurol 1995;242:(Suppl):S-115.

[4] 4. Geiman BJ, Smith AL. Dexamethasone and bacterial meningitis: a metanalysis of randomized controllled trials. West J Med 1992;157:27-31.

[5] 5. Girgis NI, Farid Z, Mikhail IA, Ferrag I, Sultan Y, Kilpatrick ME. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989;8:848-851.

[6] 6. Herson VC, Todd JK. Prediction of morbidity in H. influenzae meningitis. Pediatrics 1977;59:35-39.

[7] 7. Lebel MH, Freij BJ, Syrogiannopoulos GA et al. Dexamethasone therapy for bacterial meningitis: results of two double blind placebo controlled trials. N Engl J Med 1988;319:964-971.

[8] 8. Odio CM, Faingezcht I, Paris M et al. The beneficial effects of early dexametasone administration in infants and children with bacterial meningitis. N Eng J Med 1991 ;324:1525-1531.

[9] 9. Pfister HW, Borasie GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology 1992;42:1497-1504.

[10] 10. PfisterHW, Feiden W, Einhaupl KM. Spectrum of complications during bacterial meningitis in adults: results of a prospective clinical study. Arch Neurol 1993;50:575-581.

[11] 11. Quagliarello V, Scheld WM. Bacterial meningitis: pathogenesis, pathophysiology and progress. N Engl J Med 1992;327:864-872.

[12] 12. Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad based epidemiologic study. Medicine 1987;66:148-156.

[13] 13. Spanos A, Harrel FE, Durack DT. Differential diagnosis of acute meningitis: an analysis of the predictive value of initial observations. JAMA 1989;2700-2707.

[14] 14. Tunkel AR, Wispelwey B, Scheld M. Bacterial meningitis: recent advances in pathophysiology and treatment. Ann Intern Med 1990;112:610-623.