1. Penulis : BARAFF, LARRY J., SIDNEY I. LEE, and DAVID L. SCHRIGER

2. Judul : "Outcomes of bacterial meningitis in children: a meta-analysis."

3. Penerbit : The Pediatric infectious disease journal 

4. Tahun Publish :1993

5. Situs :http://journals.lww.com/pidj/Abstract/1993/05000/Outcomes_of_bacterial_meningitis_in_children__a.8.aspx

6. Tanggal akses : 3 oktober 2015

7. Isi :

ABSTRACT

We abstracted the results of all English language reports of the outcomes of bacterial meningitis published after 1955. We used hierarchical Bayesian meta-analysis to determine the overall and organism-specific frequencies of death and persistent neurologic sequelae in children 2 months to 19 years of age. A total of 4920 children with acute bacterial meningitis were included in 45 reports that met the inclusion criteria. Children described in the 19 reports of prospectively enrolled cohorts from developed countries had lower mortality (4.8% vs. 8.1%) and were more likely to have no sequelae (82.5% vs. 73.9%). In these 19 studies 1602 children were evaluated for at least 1 sequela after hospital discharge. The mean probabilities of these sequelae were: deafness, 10.5%; bilateral severe or profound deafness, 5.1%; mental retardation, 4.2%; spasticity and/or paresis, 3.5%; seizure disorder, 4.2%; and no detectable sequelae, 83.6%. Mean probabilities of outcomes varied significantly by etiologic bacteria, e.g. mortality: Haemophilus influenzae, 3.8%; Neisseria meningitidis, 7.5%; Streptococcus pneumoniae, 15.3%.

1. Nama : Bonsu, Bema K., and Marvin B. Harper

2. Judul : "Fever interval before diagnosis, prior antibiotic treatment, and clinical outcome for young children with bacterial meningitis." 

3. Penerbit : Clinical infectious diseases 

4. Tahun Publish :2001

5. Situs :http://cid.oxfordjournals.org/content/32/4/566.short

6. Tanggal akses : 3 oktober 2015

7. Isi :

ABSTRACT

In young children, meningitis due to Streptococcus pneumoniae is preceded by a long interval from onset of fever to diagnosis of bacterial meningitis (hereafter known as “fever interval”), during which time the patient frequently contacts a clinician. By means of retrospective chart review, we compared the fever interval that preceded diagnosis with the complication rate among 288 young children (age, 3–36 months) who had bacterial meningitis (1984–1996), as stratified by causative organism and prior antibiotic treatment. Pathogens included S. pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis. Pneumococcusspecies were associated with the longest fever interval prior to diagnosis of meningitis, the highest frequency of contact with a clinician before hospitalization, and the highest rate of documented morbidity or mortality. For S. pneumoniae, there was an association between antibiotic treatment received at prior meetings with a clinician and a reduced rate of meningitis-related complications (odds ratio, 0.14; P = .02). Antibiotic treatment during such meetings is associated with a substantial reduction in disease-related sequelae.

1. Penulis : GIRGIS, NABIL I

2. Judul : "Dexamethasone treatment for bacterial meningitis in children and adults." 

3. Penerbit : The Pediatric infectious disease journal

4. Tahun Publish :1989

5. Situs :http://journals.lww.com/pidj/abstract/1989/12000/dexamethaso ne_treatment_for_bacterial_meningitis.4.aspx

6. Tanggal akses : 3 oktober 2015

7. Isi :

ABSTRACT

Four hundred twenty-nine patients with bacterial meningitis were assigned on a nonselective alternating basis into one of two therapeutic regimens. Patients in Group I received dexamethasone in addition to standard antibacterial chemotherapy of ampicillin and chloramphenicol whereas those in Group II received antibacterial chemotherapy alone. Dexamethasone was given intramuscularly (8 mg to children younger than 12 years and 12 mg to adults every 12 hours for 3 days). Both treatment groups were comparable with regard to age, sex, duration of symptoms and state of consciousness at the time of hospitalization.A significant reduction in the case fatality rate (P < 0.01) was observed in patients with pneumococcal meningitis receiving dexamethasone; only 7 of 52 patients died compared with 22 of 54 patients not receiving dexamethasone. A reduction in the overall neurologic sequelae (hearing impairment and paresis) was observed in patients receiving dexamethasone. This reduction was significant only in patients with Streptococcus pneumoniae meningitis; none of the 45 surviving patients receiving steroids had hearing loss whereas 4 of 32 patients not receiving dexamethasone had severe hearing loss (P < 0.05). No significant difference was observed between the two groups with regard to time for patients to become afebrile or to regain consciousness or in the mean admission and 24- to 36-hour cerebrospinal fluid leukocyte count, glucose or protein content.

1. Nama : Odio, Carla M

2. Judul : "The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis." 

3. Penerbit : New England Journal of Medicine 

4. Tahun Publish :1991

5. Situs :http://www.nejm.org/doi/full/10.1056/NEJM199105303242201

6. Tanggal akses : 3 oktober 2015

7. Isi :

ABSTRACT

Considerable attention has recently been focused on the molecular pathophysiology of bacterial meningitis in an attempt to elucidate the mechanisms of meningeal inflammation and the ways they can be regulated to improve outcome for patients with the disease. It is believed that the cytokines interleukin-1β and tumor necrosis factor α (TNF-α) have a seminal role in the initial events of meningeal inflammation that eventually result in alterations in the blood–brain barrier, cerebrovascular autoregulation, cerebrospinal fluid dynamics, and brain metabolism.Therapeutic interventions to modulate cytokine production have been assessed in experimental models of meningitisand in two recently reported clinical trials of adjunctive dexamethasone therapy in infants and children with bacterial meningitis. The results of the latter studies indicated that steroid therapy significantly reduced the degree of meningeal inflammation at 24 hours and improved outcome. In those two trials dexamethasone was administered from approximately 30 minutes to many hours after the first parenteral dose of the antibiotic.In experimentally induced Haemophilus influenzae meningitis, a single dose of ceftriaxone given intravenously resulted in a 40-fold to 600-fold increase in free H. influenzae lipo-oligosaccharide concentrations in the cerebrospinal fluid two hours later, as compared with the levels in untreated animals. This response was believed to result from the release of cell-wall or membrane active components (endotoxin) from rapidly lysed microorganisms. Concentrations of TNF-α in the cerebrospinal fluid increased almost 10-fold during the same period, and there was a significant increase in the concentrations of white cells, protein, and lactate in the cerebrospinal fluid and a decrease in the glucose concentration. This effect on TNF-α activity in the cerebrospinal fluid and on

inflammation was significantly lessened if dexamethasone was given just before ceftriaxone but not if it was given one hour later. Fischer and Tomasz demonstrated similar release of cell-wall products with the addition of ampicillin to pneumococci, and Tauber and coworkers observed similar results with cefotaxime therapy in experimental models of Escherichia coli meningitis. In addition, concentrations of free endotoxin and TNF-α in the cerebrospinal fluid have been shown to increase substantially two to six hours after the first dose of ceftriaxone in infants with H. influenzae meningitis.As a consequence of these recent observations in the rabbit model of meningitis and in patients with H. influenzae meningitis, we conducted the present study, which differed in two important ways from our two previous placebo-controlled, double-blind trials of dexamethasone therapy. First, the initial dose of dexamethasone or placebo was administered 15 to 20 minutes before the first dose of antibiotic; second, opening lumbar cerebrospinal pressures were measured at diagnosis and again either 12 or 24 hours after the beginning of treatment.

1. Penulis : Beneteau, Anne

2. Judul : "Childhood Meningitis Caused by Streptococcus bovis Group: Clinical and Biologic Data During a 12-Year Period in France."

3. Penerbit : The Pediatric infectious disease journal

4. Tahun Publish :2015

5. Situs :http://journals.lww.com/pidj/Abstract/2015/02000/Childhood_Meningitis_Caused_by_Streptococcus_bovis.4.aspx

6. Tanggal akses : 3 oktober 2015

7. Isi :

ABSTRACT

Background: Bacterial meningitis (BM) is a major cause of morbidity and mortality in children. Sporadic cases of Streptococcus bovis have been described in neonates and infants. To assess the epidemiologic, clinical and biologic characteristics of this meningitis, we used the French Surveillance Network for BM in children.Methods: Two hundred and twenty-seven pediatric wards working with 168 microbiology departments throughout France were asked to report all cases of BM in patients <18 years. Diagnosis was based on a combination of fever, meningeal signs and a positive cerebrospinal fluid (CSF) culture and/or a positive polymerase chain reaction in the CSF and/or positive blood culture associated with pleiocytosis.Results: Among 4806 cases of BM recorded in 12 years (2001–2012), 23 cases were caused by S. bovis (0.5%). All were infants. Among them, 15 cases (65.2%) occurred in the neonatal period. The majority occurred in premature infants (73.9%). In 21 cases, the diagnosis was based on a positive CSF culture. Blood culture was positive in 17 children. When S. bovis subtype was identified, it was type 2 (Streptococcus gallolyticus pasteurianus) in 80% of cases. All infants received antibiotic therapy with parenteral penicillin and/or third-generation cephalosporin combined with an aminoglycoside. The duration of treatment ranged from 10 to 25 days. Of the 23 patients, 17 (73.9%) had a second lumbar puncture and in all those cases, the CSF was sterile. No deaths or neurologic complications were reported.Conclusion: BM due to S. bovis is rare and primarily affects infants, particularly premature infants. Antibiotic treatment is effective with low morbidity and mortality.

MENINGITIS, CHILD, and OUTCOMEDiajukan untuk memenuhi salah satu tugas mata kuliah keterampilan dasar (CBT)

yang diberikan oleh dr.Rizky Perdana

Disusun oleh:

Putri Anggraini Aswad (10100115013)Nurul Ayu Ade (10100115067)Ryan Zein Sembada (10100115069)Sharah Kharisma (10100115070)Galih Nadhova I (10100115071)Fitri Utami Dewi (10100115072)Alifiani Rizki W (10100115073)Intan Sawaliyah (10100115074)Heriansyah (10100115075)Nura Asri Faradilla (10100115076)M. Ichsan Hidayat (10100115077)

FAKULTAS KEDOKTERANUNIVERSITAS ISLAM BANDUNG

2015-2016

1. Penulis : G. V. Ramadevi Venkatashetty Sardar Sulthana M. Suhasini, V. V. Ratnakar Reddy

2. Judul : CLINICAL PROFILE OF ACUTE BACTERIAL MENINIGITS AND OUTCOME

3. Penerbit : Journal of Evolution of Medical and Dental Sciences

4. Tahun Terbit : Januari 2015

5. Situs :http://jemds.com/latest-articles.php?at_id=6530

6. Tanggal Akses :3 Oktober 2015

7. Isi :

ABSTRACT

OBJECTIVES: To study the clinical profile of ABM and analyse the differences in clinical presentation among young infant, toddler, compared to school going children. and to find out the bacteriological profile and sensitivity pattern of ABM. MATERIALS AND METHODS: The present study is a prospective non-randomized single arm study. Children with the diagnosis of ABM admitted to the department of Pediatrics Govt. General Hospital, Kurnool from January 2013 to October 2013 are included in the study. Clinical details of all patients were recorded CSF was analysed by routine biochemical methods, and microbiological studies on special media. The children were managed as per the standard protocols.RESULTS: In a study period of 1 year During the study period 74 children (1.5% of all admissions) satisfied the criteria of ABM in early childhood;. The incidence of Acute Bacterial Meningitis was 1.45% of total Pediatric admissions. Of the 74 cases 25 died. Mortality rate was 33.79%.mortality observed was more in less than one year of age. Chief presentation was high fever, refusal of feeds, altered sensorium and seizures. the final etiological diagnosis (as per LAT and/or cultures) were 32 cases are positive for culture and sensitivity of ABM and Biochemically and Cell count wise 74 cases are positive for ABM. CSF has grown pneumococci in 8 (25%) cases, Coagulase positive Staph. aureus in 3 (9.38%) cases, Coagulase negative Staph. aureus in 3(15.63%) cases, Nesseria Meningitides in 3 (9.38%), Klebsiella in 4 (12.50%) cases, E coli, Enterococci and Pseudomonous in 9 (28.13%) The outcome in the present study with respect to death is 33.78% and 45.95% of patients Survived with complications, 20.27% of patients survived without

complications. CONCLUSION: The incidence and Mortality were significantly high in low socio economic group. The incidence and mortality was high in lesser age group. Mortality is very high with high CSF protein and low sugar levels. Pneumococci and coagulase negative staphylococci are predominant causes of morbidity and mortality associated with ABM.

1. Penulis : Keith Grimwood Peter Anderson Vicki Anderson Lesley Tan Terry Nolan

2. Judul : TWELVE YEAR OUTCOMES FOLLOWING BACTERIAL MENINGITIS: FURTHER EVIDENCE FOR PERSISTING EFFECTS

3. Penerbit : www.archdischild.com

4. Tahun Publish : 15 Februari 2000

5. Situs :http://m.adc.bmj.com/content/83/2/111.full.pdf

6. Tanggal Akses :3 Oktober 2015

7. Isi :

ABSTRACT

Aim—To determine whether intellectual and cognitive impairments observed seven years following early childhood bacterial meningitis persist into adolescence. Methods—Blinded neuropsychological, auditory, and behaviour assessments were conducted in 109 (69%) subjects from an original cohort of 158 children, seven and 12 years after their meningitis, and in 96 controls. Results—Meningitis subjects remained at greater risk than controls for any disability (odds ratio OR 4.7, confidence interval 2.2 to 9.6). Those with acute neurological complications had more sequelae than children with uncomplicated meningitis or controls (47% v 30% v 11.5% respectively; p < 0.001). Differences in intellectual, academic, and high level cognitive function between subjects and controls were maintained at the seven and 12 year assessments. In contrast, lower order skills improved, while behaviour scores deteriorated significantly (p = 0.033). Conclusions—Many of the deficits identified at the seven year follow up persist 12 years after an episode of bacterial meningitis.Bacterial meningitis is a severe childhood illness. While Haemophilus influenzae type b(Hib) disease has been virtually eliminated from North America, northern Europe, Australia, and New Zealand,1 in developing countries it is a leading cause of bacterial meningitis,2 responsible for over 200 000 cases and more than 40 000 deaths annually.2 3 Moreover, Neisseria meningitidis and Streptococcus pneumoniae remain important pathogens.4 Recurring epidemics of meningococcal disease,5 increased antibiotic resistance among pneumococci,6 and failure to introduce conjugate Hib vaccines into many developing countries means that bacterial meningitis remains a serious global health problem. In spite of potent antibiotics and improved management of the critically ill, there is a small and significant risk of death or

severe neurological sequelae following bacterial meningitis in childhood. A meta analysis found that 4.5% died and at least one major adverse outcome (severe intellectual disability, epilepsy, spasticity, deafness) was present in 6.4% of survivors.7 Inasmuch as these studies were limited to neurological examinations and tests of general intellectual function or hearing acuity, with assessments restricted to one or two years follow up, the long term sequelae may havebeen underestimated. Many motor and cognitive skills are undeveloped at the time of meningitis. Consequently, functionally important deficits may not appear until the children are much older, attending school, and expected to think and reason independently. Most meningitis survivors are considered to lead normal lives8 and to be little different from their siblings.9 Despite these impressions, a prospective seven year follow up study of children surviving bacterial meningitis and their classroom peers showed that these primary school age survivors showed mildly decreased intellectual quotient (IQ) scores and consistently performed less well with neuropsychological tasks, being more likely to have abnormal findings across all categories tested.10 The pattern of results suggested that their greatest impairment as in verbal skills and organisational capacity.11 Compared with 11% of controls exhibiting minor disabilities, 27% of children surviving meningitis had either neurological and behaviour disorders or cognitive impairments that may have contributed to their poorer academic performance. The risks for these adverse outcomes were greatest in those with meningitis during infancy and where there had been delays in diagnosis or acute neurological complications.11 12 The present study aimed to reassess the original cohort 12 years after their meningitis when many were early high school age. We determined whether previously observed disabilities persisted, suggesting permanent neurological deficits, if there was delayed acquisition of skills that improved with maturity, and if new deficits emerged with development.

1. Penulis : Jillian Mongelluzzo Zeinab Mohamad Thomas R. Ten Have, PhD Samir S. Shah, MD, MSCE

2. Judul : CORTICOSTEROIDS AND MORTALITY IN CHILDREN WITH BACTERIAL MENINGITIS 

3. Penerbit : THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

4. Tahun Publish : 7 Mei 2008

5. Situs :http://jama.jamanetwork.com/article.aspx?articleid=181852

6. Tanggal Akses :3 Oktober 2015

7. Isi :

ABSTRACT

Adjuvant corticosteroid therapy reduces hearing loss in children with meningitis caused by Haemophilus influenzae type b (Hib). However, the epidemiology of bacterial meningitis has changed dramatically following the licensure and widespread use of vaccines against Hib in 1985 and Streptococcus pneumoniaein 2000. The current benefit of adjuvant corticosteroids for the treatment of bacterial meningitis in children remains unclear. Guidelines from the Committee on Infectious Disease of the American Academy of Pediatrics acknowledge this uncertainty and state that for infants and children aged 6 weeks or older, “adjunctive therapy with dexamethasone may be considered after weighing the potential benefits and risks.” Adjuvant corticosteroids, when used, should be administered with or shortly before the first dose of antimicrobial therapy.

Antimicrobial-induced bacteriolysis leads to inflammation and cerebral edema. The beneficial effects of corticosteroids are attributed to attenuation of this inflammatory response. Concerns over the use of corticosteroids relate to the potential for decreased cerebrospinal fluid (CSF) penetration of antibiotics and potential adverse effects of corticosteroids, namely gastrointestinal bleeding. Other concerns with corticosteroid use include the potential to mask antimicrobial failure by preventing a secondary fever.

In adults, adjuvant corticosteroids decrease mortality in patients with bacterial meningitis, with the greatest benefit occurring in the subset of patients with pneumococcal meningitis. In neonates and children, the effect of

corticosteroids on mortality is controversial. Only 1 small clinical trial specifically evaluated corticosteroids in neonates; however, the study was not included in a large Cochrane review. The results of that study of neonates by Daoud et al showed no difference in mortality between treatment and control groups. A retrospective study of 120 children with pneumococcal meningitis conducted between 1994 and 1999 found that adjuvant corticosteroid use was associated with a lower odds of death in adjusted analysis.However, a subsequent Cochrane review of randomized controlled trials from 1969 to 2006 found no significant difference in mortality in children younger than 16 years who received corticosteroids compared with those who did not receive corticosteroids for all causative organisms, although the overall mortality rate was lower than previously reported in some of the studies. Furthermore, few of these studies were conducted in the United States.

In a multicenter randomized controlled trial conducted in Latin America not included in the Cochrane review, adjuvant corticosteroids had no effect on mortality in children aged 2 months to 16 years. However, the study was performed in areas where Hib accounted for most cases of meningitis. Also, in contrast with previous work, the study found no protection against hearing loss in the 54 children with Hib meningitis who received adjuvant corticosteroids compared with controls.A more recent randomized trial in Vietnam found that adjuvant corticosteroids decreased overall mortality in those individuals with culture-confirmed bacterial meningitis. The study included adults and adolescents; however, the results were not stratified by age.

The goal of our study was to determine the effect of adjuvant corticosteroid therapy on mortality and length of hospitalization in children with bacterial meningitis treated at tertiary care children's hospitals in areas where Hib meningitis is no longer prevalent.

1. Penulis : Nandita Chinchankar Meenakshi Mane Sheila Bhave, Swatee Bapat Ashish Bavdekar Anand Pandit, K.B. Niphadkar Anil Dutta Didier Leboulleux

2. Judul : DIAGNOSIS AND OUTCOME OF ACUTE BACTERIAL MENINGITIS IN EARLY CHILDHOOD 

3. Penerbit : INDIAN PEDIATRICS

4. Tahun Publish : Oktober 2002

5. Situs :http://www.indianpediatrics.net/oct2002/oct-914-921.htm

6. Tanggal Akses :3 Oktober 2015

7. Isi :

ABSTRACT

Objective:To estimate frequency of acute bacterial meningitis (ABM) in early childhood in hospital admissions, to describe clinical and diagnostic features, and to analyze mortality, complications and long term sequelae. Design: Prospective study. Setting: Pediatric wards and Rehabilitation Center of KEM Hospital, Pune. Method: Study subjects between the ages of 1 months to 5 years with ABM were recruited. Clinical details were recorded. CSF was analysed by routine biochemical methods, antigen detection tests (Latex agglutination LAT) and microbiological studies on special media. Management was as per standard protocols. Survivors were followed up long term with neurodevelopmental studies and rehabilitation programmes. Results: In a study period of 2 years, 54 children (1.5% of all admissions) satisfied the criteria of ABM in early childhood; 78% were below one year and 52% were under the age of six months. Chief presentation was high fever, refusal of feeds, altered sensorium and seizures. Meningeal signs were present in only 26%. CSF C-reactive protein was positive in 41%, gram stain was positive in 67%, LAT in 78% and cultures grew causative organisms in 50% of the cases. The final

etiological diagnosis (as per LAT and/or cultures) were Streptococcus pneumoniae 39%, Hemophilus influenzae type b 26% and others in 35%. The others included one case of Neisseria meningitidis and 10 who were LAT negative and culture sterile. 39% patients developed acute neurological complications during the hospital course. 31% children with ABM died in hospital or at home soon after discharge. Six were lost to follow up. Of the 31 children, available for long term follow up (1-3 years), 14 (45%) had no sequelae. The remaining had significant neurodevelopmental handicaps ranging from isolated hearing loss to severe mental retardation with multiple disabilities. Conclusion:ABM in early childhood has a considerable mortality, morbidity and serious long term sequelae. Neurodevelopmental follow up and therapy should begin early. Etiological diagnosis can be enhanced by LAT and good culture media. H. influenzae b and S. pneumoniae account for more than 60% of ABM in early childhood.

Key words: Acute bacterial meningitis, Long term Sequelae.

ACUTE bacterial meningitis (ABM) is an important disease of early childhood, with high case fatality and risk of neurologic handicaps(1). The community incidence of ABM in India is not known. The exact etiological diagnosis is often not possible, because of poor culture facilities(2,3). The three organisms commonly associated with ABM in early childhood in western countries are Hemophilus influenzae type b, S. Pneumoniae and Neisseria meningitidis. However, the etiology may vary in different parts of the world(1). Many of these infections are likely to be preventable in the near future(4,5). We have prospectively examined the hospital based frequency of ABM in early childhood, especially in relation to its etiology. The clinical and diagnostic features, mortality, complications and especially long term sequelae were also analysed

1. Penulis : Rianne Oostenbrink Mariëlle Maas Karel G. M. Moons Henriëtte A. Moll

2. Judul : SEQUELAE AFTER BACTERIAL MENINGITIS IN CHILDHOOD

3. Penerbit : SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES

4. Tahun Publish : 08 Jul 2009

5. Situs :http://www.tandfonline.com/doi/pdf/10.1080/00365540110080179?redirect=1#.VhE46jEkSSo

6. Tanggal Akses :3 Oktober 2015

7. Isi :

ABSTRACT

The neurological outcome of bacterial meningitis in children was evaluated retrospectively. Data were obtained from a large study on children aged between 1 month and 15 y who initially visited the emergency department of Sophia Children's Hospital, Rotterdam, The Netherlands with meningeal signs. This study presents data from 103 patients in whom bacterial meningitis was diagnosed. Neisseria meningitidis was the dominant pathogen of meningitis. We found a 2% case-fatality rate in children with bacterial meningitis and a 13% rate of sequelae among survivors: 7% hearing impairment and 7% neurological sequelae. Children with bacterial meningitis caused by Streptococcus pneumoniae and those with acute focal neurological symptoms tended to have the worst prognosis.

1. Penulis :

Tessa Goetghebuer, 

T. Eoin West,

Vanessa Wermenbol, 

Anna Louise Cadbury, 

Paul Milligan, 

Nellie Lloyd-Evans, 

Richard A. Adegbola, 

E. Kim Mulholland, 

Brian M. Greenwood and

Martin W. Weber2. Judul :

OUTCOME OF MENINGITIS CAUSED BY STREPTOCOCCUS PNEUMONIAE ANDHAEMOPHILUS INFLUENZAE TYPE B IN CHILDREN IN THE GAMBIA

3. Penerbit : The European Journal Tropical Medicine & International Health

4. Tahun Publish : 25 Desember 2001

5. Situs :http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.2000.00535.x/abstract

6. Tanggal Akses :3 Oktober 2015

7. Isi :

ABSTRACT

In developing countries, endemic childhood meningitis is a severe disease caused most commonly by Streptococcus pneumoniae or Haemophilus influenzae type b (Hib). Although many studies have shown that fatality rates associated with meningitis caused by these organisms are high in developing countries, little is known about the long-term outcome of survivors. The purpose of this study was to assess the importance of disabilities following pneumococcal and Hib meningitis in The Gambia. 257 children aged 0–12 years hospitalized between 1990 and 1995 with culture-proven S. pneumoniae (n = 134) or Hib (n = 123) meningitis were included retrospectively in the study. 48% of children with pneumococcal meningitis and 27% of children with Hib meningitis died whilst in

hospital. Of the 160 survivors, 89 (55%) were followed up between September 1996 and October 1997. Of the children with pneumococcal meningitis that were traced, 58% had clinical sequelae; half of them had major disabilities preventing normal adaptation to social life. 38% of survivors of Hib meningitis had clinical sequelae, a quarter of whom had major disabilities. Major handicaps found were hearing loss, mental retardation, motor abnormalities and seizures. These data show that despite treatment with effective antibiotics, pneumococcal and Hib meningitis kill many Gambian children and leave many survivors with severe sequelae. Hib vaccination is now given routinely in The Gambia; an effective pneumococcal vaccine is needed.