A descriptive study of meningeal pathogens cultured from the general paediatric wards in Chris Hani Baragwanath Hospital, 2012 to 2020

Abstract

Background Meningitis is a leading cause of childhood morbidity and mortality, with an incidence of 7/100,000 children aged 1-4 years and 40/100,000 in infants in South Africa. Since the incorporation of protein-polysaccharide vaccines to prevent infections due to Haemophilus influenzae type b and pneumococcus into the South African immunisation programme, the epidemiology of meningitis in South Africa is changing. Methods We reviewed the clinical and laboratory characteristics, and clinical outcomes of children aged 0 to 14 years of age that were hospitalised with meningitis in the general paediatric wards at a public sector teaching hospital in South Africa from 01 January 2012 through 31 December 2020. Results During the study period, 1,617 episodes of meningitis were diagnosed in 1,597 children. Me- dian age at hospitalisation was 6.0 months (interquartile range (IQR), 1.2 to 38.6 months). Most (1,243/1,617, 78.9%) of the episodes occurred in HIV-uninfected children, 182 (11.2%) in HIV-infected children and 192 (11.8%) in children with undetermined HIV infection status. Two hundred, fifty-four (15.7%) episodes were microbiologically confirmed, and 1,268 (78.4%) were clinically diagnosed with no microbiological confirmation. Coagulase negative staphy- lococci (n=77), Streptococcus pyogenes (n=76) and pneumococcus (n=54) were the most frequently isolated organisms. The crude mortality rate was 8.5% (137/1,617). Using three multivariable logistic regression modelling approaches, HIV infection was consistently associ- ated with mortality (adjusted odds ratios ranging from 3.658 (95% confidence interval (CI), 1.645-8.133) to 4.070 (95% CI, 1.474-11.235)). A composite measure of low cerebrospinal fluid (CSF) to plasma glucose ratio, raised CSF protein and raised C-reactive protein was iv independently associated with a 3.413 (95% CI, 1.88-6.196) increased adjusted odds of death. Conclusions Most cases of meningitis are clinically diagnosed, and when microbiologically confirmed are caused predominantly by Gram positive organisms. HIV infection is consistently associated with worse outcomes. Biochemical parameters may be useful to prognosticate in children diagnosed with meningitis.