Acute Meningitis in Children:Clinical and Laboratory Profiles

الملخص

Background: Meningitis is a significant cause of morbidity and mortality in children around the world . Early diagnosis and treatment are the most important way in prevention of the complications.
Objective: To estimate the frequency and types of meningitis, to describe various clinical and laboratory parameters, and to analyze mortality and early complications of childhood meningitis. Patients and methods: One hundred Children aged 1 month-15 years admitted to AL-Zahra Teaching Hospital in Wassit, with clinical suspicion of meningitis during the period from 1st January 2009 to 1st January 2010 were included in this study. They were subjected to clinical examination , blood tests and cerebrospinal fluid tests (CSF) which include: biochemical, bacteriological, and serological tests.
Results: Thirty of the patients had bacterial meningitis, 34% had viral meningitis, 36% had partially treated bacterial meningitis. Majority of the patients admitted in January and February. Fever was the most common presenting symptom (94%) , followed by vomiting in 64%, poor feeding or appetite in 65%. Irritability and bulging fontanel were the main signs in those children below one year. Neck stiffness and positive kernig sign were the main signs in children above one year. The results of Cerebrospinal fluid studies in patients with bacterial meningitis were as following : (gram stain was positive in 18 (60%) patients, culture was positive in 22 (73%) patients, C-reactive protein (CRP) was positive in 23 (77%) patients). Serum C-reactive protein was positive in 16 (53%) patients with bacterial meningitis. Haemophilus influenza (H.influenza) was the main causative agent of bacterial meningitis. The main complication was recurrent convulsion (27% of bacterial meningitis,8% of viral meningitis, 5% of partially treated bacterial meningitis).Two cases required admission to intensive care unit. The overall mortality rate was 8%.
Conclusion: H. influenza type B is the leading causative agent of bacterial meningitis. Fever was the most common presenting signs , recurrent convulsion was the most frequent complication in all age groups and in all types of meningitis. Positive C- reactive protein in the Serum and CSF was mainly found in patients with bacterial meningitis.