A review of bacterial meningitis in paediatric patients admitted to the emergency department of Charlotte Maxeke Johannesburg academic hospital

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. 7 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.