A review of bacterial meningitis in paediatric patients admitted to the emergency department of Charlotte Maxeke Johannesburg academic hospital
Date
2016
Authors
Harris, Kim
Journal Title
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Abstract
The morbidity and mortality of paediatric patients with bacterial meningitis are significantly
higher in developing countries than in developed countries. We do not know the outcome of
bacterial meningitis in our setting of a developing country where HIV and poor
socioeconomic factors may be significant confounding factors.
Purpose of Study
To assess the neurological sequelae and mortality rates of paediatric patients with bacterial
meningitis and to evaluate the risk factors for morbidity and mortality within this population.
Method
This is a retrospective observational analysis of medical records of paediatric patients aged
1 month – 14 years, with bacterial meningitis admitted to the Emergency Department at
Charlotte Maxeke Johannesburg Academic Hospital over a 3-year period (2011 - 2013).
Results
One hundred and seventy one patients were enrolled with only 48 (28%) patients having
confirmed meningitis. Thirty seven (77%) were male, 11 (23%) were female and 30 (62.5%)
were under 12 months of age. Thirty three (68.7%) were HIV negative and 7 (14.6%) were
HIV positive. No deaths were recorded.
In terms of Herson Todd Score (Appendix 1) where scores were >4.5, only 1 (2%) patient
had a GCS <8/15, 18 (37.5%) had duration of illness longer than 3 days at the time of
admission and 3 patients had body temperatures recorded below 36.6 degrees Celsius. Two
(4.2%) presented in status epilepticus.
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Within the meningitis group, neurological sequelae and hearing loss had high scores on the
HTS. However, the HTS did not demonstrate a high predictor of morbidity in terms of visual
disturbances or empyemas.
Two (5.7%) patients had spastic quadriplegia, 9 (18.75%) had a hemiplegia and 1 (2.08%)
had ataxia. Three (6.25%) children had cranial nerve palsies.
Hydrocephalus was found in 2 (4.7%) patients, empyema / abscess in 3 (6.25%) and 3
(6.25%) had visual disturbances; one had diplopia. Hearing loss occurred in 3 (6.25%)
children.
The commonest organism cultured on blood and cerebrospinal fluid was Neisseria
meningitidis, followed closely by Streptococcus pneumoniae.
Conclusion
There were no deaths recorded in patients diagnosed with meningitis. HIV status was
positive in less than 15% of patients. Most patients were under one year of age. The main
pathogen for meningitis was N. Meningitidis followed by S. Pneumoniae. A third of patients
developed neurological sequelae. HTS showed a high predictor of morbidity in neurological
sequelae, and hearing loss but not for visual disturbances nor empyema/ abscess.
The acute complication rate was low compared to developing countries.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Paediatrics and Child Health.
December 2016