Long-term sequelae of group B streptococcal meningitis in infants

The long-term outcome and admission features predictive of outcome were determined for 61 patients with group B streptococcal meningitis treated between 1974 and 1979. Infection was rapidly fatal in 13 patients (21%). Among the 48 survivors, 38 (79%) 3 years of age or older were available for comprehensive evaluation. Excluding five who had died before age 3 years, the mean age at evaluation was 6.0 years (range 3.3 to 9.0 years). Among survivors, 11 (29%) had severe neurologic sequelae, eight (21%) had mild to moderate deficits, and 19 (50%) were functioning normally. Analysis of predictive features revealed a significant risk of death or severe impairment among infants who at hospital admission were comatose or semicomatose, had decreased perfusion, total peripheral WBC less than 5,000/mm3, absolute neutrophil count less than 1000/mm3, and CSF protein greater than 300 mg/dl (P less than or equal to 0.05). These data indicate that, although mortality from group B streptococcal meningitis has declined, approximately half of the survivors of acute infection have some degree of morbidity when evaluated at ages permitting the detection of language delay and borderline or mild mental retardation.     

Prediction of neurologic sequelae in childhood tuberculous meningitis: a review of 20 cases and proposal of a novel scoring system

BACKGROUND: Despite effective antituberculous medications, the mortality and morbidity remain high in children with tuberculous meningitis (TBM). The traditional clinical staging for TBM developed by Lincoln et al in 1960 has been widely used to predict long term neurologic sequelae (NS). In the current era of critical care medicine and corticosteroid therapy, a new scoring system is needed to predict NS more accurately in children with TBM. METHODS: We reviewed all available cases of TBM in San Diego, CA, during 1991-2001 retrospectively, and we developed a novel scoring system to predict NS in children with TBM. We assessed a tuberculous meningitis acute neurologic (TBAN) score at day 0 and on day 3 of hospitalization, to compare children who subsequently developed severe NS with those who did not. RESULTS: Among 20 children with TBM, 7 children developed severe NS and 1 child died during hospitalization. The TBAN score was higher on day 0 in those with severe NS (5.5 versus 2.0, P = 0.09), and the difference became statistically significant by day 3 of hospitalization (5.5 versus 0.0, P = 0.02). Sensitivity and specificity of the TBAN score (> or =4) on day 0 (75 and 92%) and day 3 (88 and 100%) to predict severe NS were superior to the traditional clinical staging system on day 0 (63 and 58%). CONCLUSIONS: The TBAN score is an objective marker for predicting severe NS in children with TBM.     

The frequency of pericardial effusions in bacterial meningitis.

Because of our experience with four cases of purulent pericarditis complicating bacterial meningitis during a 13-month period, we performed a prospective study to determine the frequency of this complication. Echocardiograms were done on 100 patients with bacterial meningitis. Small or moderate pericardial effusions were detected in 19 patients, but none had symptoms or signs related to the effusion. Pericardiocentesis was done in one infant; all the other effusions resolved spontaneously. Patients with effusion were significantly younger than those without this complication, but no other significant risk factors were identified. A literature survey indicated that symptomatic pericarditis occurs in fewer than 1% of patients with meningitis. Conversely, in series of cases of purulent pericarditis, associated meningitis was reported in 12% of patients. We concluded that pericardial infection is common in patients with meningitis but that it is usually of no clinical significance and resolves with antibiotic therapy.     

Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study

One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on longterm follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.     

Sonographic findings in bacterial meningitis in neonates and young infants

Cranial sonography plays an important role in the initial evaluation of infants with suspected bacterial meningitis and in monitoring for complications of the disease. Echogenic widening of the brain sulci, meningeal thickening and hyperemia suggest the diagnosis in an at-risk population. Sonography can identify the presence of extra-axial fluid collections, and color Doppler sonography can be very helpful in differentiating benign enlargement of subarachnoid spaces from subdural effusions. Intraventricular debris and stranding, and an irregular and echogenic ependyma are highly suggestive findings associated with ventriculitis. Sonography can play an important role in the detection of postinfectious hydrocephalus, in the determination of the level of obstruction, and in the evaluation of intracranial compliance. Focal or diffuse parenchymal involvement can represent parenchymal involvement by cerebritis, infarction, secondary hemorrhage or early abscess.     

Quantitative chloramphenicol detection in serum and cerebrospinal fluid of infants with bacterial meningitis

Twenty-six meningitic infants aged less than one year were administered daily oral or intravenous doses from 44 to 170 mg chloramphenicol per kg body weight. Serum levels measured were 5.4 to 55.0 micrograms.ml-1, and CSF concentrations from 0.9 to 20.2 micrograms.ml-1 were noted. Since, in particular for younger infants, (i) there is no clear relationship between dose and blood level and (ii) one cannot unambiguously infer the CSF concentration from the blood level we recommend that initial doses for meningitic infants be chosen according to age-adjusted dosage instructions and, from day 2 onwards, doses be corrected as a function of CSF and blood levels (CSF greater than 10 micrograms.ml-1 and serum less than 50 micrograms.ml-1).     

Concomitant aseptic meningitis and bacterial urinary tract infection in young febrile infants.

We evaluated the incidence and implications of coexistent bacterial urinary tract infection and aseptic meningitis in 1629 young febrile infants (age 1 to 60 days) who underwent sepsis work-up. Urinary tract infection was diagnosed in 13.2% and aseptic meningitis in 8.8%. Eleven patients (0.7%) had both infections. In view of possible coinfection initial laboratory results may be insufficient for decision-making regarding treatment in young febrile infants.     

A revised clinical method for assessment of severity of acute bacterial meningitis

The aim of this study was to simplify a previously described clinical method of assessing severity of meningitis. An 8.5-point, six-item model for the risk of an abnormal course (seizures during treatment) or adverse outcome (death or recovery with neurological sequelae) was developed using a set of six bedside features: age < or = 2 yrs, 2 points; duration of illness > 7 days, 1.5 points; seizures, 2.5 points; hypovolaemic shock, 1 point; coma, 0.5 point; and abnormal muscle tone, 1 point. A high-risk score (< or = 2.5 points) was associated with a relative risk (95% CI) of 7.4 (2.4, 22.7) of seizures during treatment, and 6.3 (2.6, 17.2) for an adverse outcome (death or major or minor sequelae). The revised model should be suitable for use where laboratory facilities are not readily available, as in many developing countries, or when contra-indications to lumbar puncture are an important consideration on admission, as in severely ill patients, as well as when there are not such limitations.     

A disease severity scoring system for children with type 1 Gaucher disease

Almost half of patients with Gaucher disease are diagnosed by the age of 10 years, and approximately two thirds are diagnosed by the age of 20 years. Besides symptomatic children, some presymptomatic children are being diagnosed through community screening programs and because of affected siblings. In addition, it is anticipated that in the near future, newborn screening for lysosomal diseases such as Gaucher disease will be introduced in the USA, identifying additional pre/nonsymptomatic children. Currently, there is no severity scoring system for children. A validated disease severity scoring system in the pediatric Gaucher population will be essential for classifying disease severity in these children, monitoring their disease progression, making decisions about when to treat them, and monitoring disease improvement with therapy. A severity scoring system will also be helpful in comparing therapeutic options as new therapies are designed. Therefore, a Pediatric Gaucher Severity Scoring System (PGS3) was devised using expert opinion and validated in 26 patients with type 1 Gaucher disease. The PGS3 correlates well with disease severity in patients at diagnosis and over time. Conclusion: A practical system that will help clinical management, based on signs and symptoms in children with type 1 Gaucher disease, is presented.     

Multistage scoring system for identifying infants at risk of unexpected death.

Obstetric and perinatal records have been assembled on 250 infant deaths and an equal number of live controls including 55 deaths associated with congenital anomalies. The information was used to construct a scoring system to identify high-risk infants at birth. Parents of 115 of the cases and their controls were also interviewed and all hospital, general practitioner, and health service records abstracted. Cases and controls were compared item by item in respect of all information available up to the age of one month and a scoring system constructed for use at one month. The ''at birth'' and combined scoring systems are presented. The chance of death by age attained is presented for various risk groups. In a small prospective test, the multistage scoring system was nearly 50% more effective than the birth score alone.     

新生儿细菌性脑膜炎合并低钠血症20例临床探讨

目的探讨新生儿细菌性脑膜炎合并低钠血症的原因及干预方法。方法回顾性分析20例新生儿细菌性脑膜炎合并低钠血症的临床资料。结果患儿均表现为血钠下降，尿钠升高，血浆平均渗透压下降。其中12例有脱水、低血容量表现者，在综合治疗的基础上输液、补钠治疗；8例无脱水、低血容量表现者，予限制液体入量、限钠治疗。全部病例1～3d血钠恢复正常，治愈12例，好转6例，死亡2例。结论新生儿细菌性脑膜炎合并低钠血症系脑性耗盐综合征和抗利尿激素分泌异常综合征所致，治疗应具有针对性。早期纠正低钠血症在脑水肿的治疗中具有重要意义。     

足月儿与早产儿细菌性脑膜炎的临床分析

目的 探讨足月儿和早产儿细菌性脑膜炎的临床特征及转归特点。方法 回顾性分析102例新生儿细菌性脑膜炎患儿的临床资料,根据胎龄分为早产儿组（n=46）及足月儿组（n=56）,比较两组患儿临床表现、实验室结果、影像学结果及临床转归。结果 早产儿组临床表现主要为反应差和呼吸暂停/急促（P < 0.05）,足月儿组则以发热及抽搐多见（P < 0.05）。足月儿组脑脊液糖高于早产儿组（P < 0.05）,早产儿组C-反应蛋白、血培养阳性率及不良预后发生率高于足月儿组（P < 0.05）。两组外周血白细胞计数、脑脊液白细胞、脑脊液蛋白及脑脊液培养阳性率差异无统计学意义（P > 0.05）。结论 早产儿及足月儿细菌性脑膜炎临床表现有所不同,早产儿组不良预后发生率更高。