Clinical data in children with meningococcal meningitis in a Spanish hospital

• Published in: Acta Paediatrica Vol. 86; no. 1; pp. 26 - 29
• Main Authors: Cubells, C Luaces, García, JJ García, Martinez, J Roca, Otin, C Latorre
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.1997; Blackwell
• Subjects: Adolescent; Age Distribution; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Bacterial meningitis; Biological and medical sciences; Child; Child, Preschool; Female; Hospital Mortality; Human bacterial diseases; Humans; Infant; Infant, Newborn; Infectious diseases; Male; Medical sciences; Meningitis, Meningococcal - complications; Meningitis, Meningococcal - diagnosis; Meningitis, Meningococcal - microbiology; Meningitis, Meningococcal - mortality; Microbial Sensitivity Tests; Neisseria meningitides; Penicillin Resistance; Prognosis; Retrospective Studies; Risk Factors; Spain; Time Factors; Europe; Spain; Human; Infection; Symptomatology; Treatment; Bacteriosis; Evolution; Meningitis; Infant; Diagnosis; Child; Meningococcal disease
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.1997.tb08826.x

Neisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19h, p= 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p= 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+= 25h, GS‐= 16h, p= 0.004; CSF+= 20h, CSF‐= 12h, p= 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC+= 14 h, BC = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) (p= 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third‐generation cephalosporine.