Clinical data and factors associated with poor outcome in pneumococcal meningitis

• Published in: European journal of pediatrics 2006-05, Vol.165 (5), p.285-289
• Main Authors: CASADO-FLORES, Juan, ARISTEGUI, Javier, RODRIGO DE LIRIA, Carlos, MARTINON, Jose Maria, FERNANDEZ, Cristina
• Format: Article
• Language: English
• Subjects: Anisocoria - microbiology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biological and medical sciences; Cephalosporins - therapeutic use; Child, Preschool; Coma; Confidence intervals; Dexamethasone - therapeutic use; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Drug Resistance, Bacterial; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Female; General aspects; Glucocorticoids - therapeutic use; Glucose - cerebrospinal fluid; Hearing loss; Hearing Loss, Sensorineural - microbiology; Humans; Hydrocephalus; Hydrocephalus - microbiology; Hypernatremia - complications; Hypotheses; Immunization; Infant; Leukocyte Count; Leukocytes; Male; Medical sciences; Meningitis; Meningitis, Pneumococcal - complications; Meningitis, Pneumococcal - drug therapy; Meningitis, Pneumococcal - epidemiology; Mortality; Nervous system (semeiology, syndromes); Neurology; Non tumoral diseases; Otitis Media - complications; Otorhinolaryngology. Stomatology; Outcome Assessment (Health Care); Paresis - microbiology; Pediatrics; Penicillin; Prospective Studies; Reflex, Pupillary; Retrospective Studies; Seizures - microbiology; Spain - epidemiology; Streptococcus infections; Vaccines; Variables
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-005-0024-9

We carried out a 4-year study of 159 children (ages 1 month-14 years) with pneumococcal meningitis. The study was divided into two periods: the retrospective period (1998-2000: 107 patients), and the prospective period (2001-2002: 52 patients). About 2/3 of the children were under 2 years of age: 72 (45%) were under 1 year of age and 38 (24%) had meningitis during the second year of life. One-third of the patients had signs of otitis media; convulsions were more frequent in patients under 1 year compared with older patients (34.7 vs. 14.9%; P=0.004); 13/159 children (8.2%) died; 93/159 (58.5%) recovered completely, 12.6% had motor sequelae, 6.9% hydrocephalus, 29.8% sensorineural hearing loss; 140/159 (88%) were treated with third generation cephalosporins, yet only 8.7% of the pneumococci identified were completely penicillin-resistant (> or =1 microg/ml); 119/159 were treated with dexamethasone. Four patients had received an injection of heptavalent vaccine. Antibiotics for 1 week prior to admission, shock, abnormal pupils, leukocytes count 16,000/mm(3) died. Conclusion. Sequelae are very common in pneumococcal meningitis. Poor outcome was associated with pupillary abnormality and a leukocyte count