Aetiology and clinical signs of bacterial meningitis in children admitted to Goroka Base Hospital, Papua New Guinea, 1989–1992

Abstract

Children aged 1-59 months admitted to Goroka Base Hospital with signs suggestive of meningitis were recruited to determine what proportion of such children have clinical or bacterial meningitis and to investigate the bacterial aetiology. A laboratory classification of definite, probable, possible, indeterminate and no meningitis was established. Thirty per cent of 697 children had a final clinical diagnosis of meningitis, 12% had culture-proven bacterial meningitis (case fatality rate 34%) and 10% had probable or possible meningitis. Inability to feed, vomiting, drowsiness, "staring eyes" and haemoglobin < 9 g/dl in addition to the classical signs of meningitis were associated with increased mortality. Isolates from cerebrospinal fluid were 62 pneumococci, 22 Haemophilus influenzae type b (Hib) and one Neisseria meningitidis. Including blood culture-proven and antigen-proven Hib disease, Hib and pneumococci accounted for 44% and 46% of bacterial meningitis, respectively, and 23% of pneumococci were intermediately resistant to penicillin. Inability to feed, bulging fontanelle, convulsions in young children, neck stiffness, fever and "staring eyes" were all independently associated with bacterial meningitis. Conjugate Hib vaccine must be given to infants as early as possible. Conjugate pneumococcal vaccines, maternal immunization with 23-valent vaccine and pneumococcal protein vaccines are under investigation for prevention of pneumococcal disease.

Indicators of Acute Bacterial Meningitis in Children at a Rural Kenyan District Hospital

“…A lack of independent association between meningitis and seizures per se within the age range for febrile convulsions in hospitalized children has also been reported from children in Papua New Guinea. 15 Notably, we found that 20% of admissions with seizures outside the age range for febrile convulsions and 10% of children with partial seizures had meningitis.…”

“…When culture is negative, "possible" or "probable" cases are typically defined by CSF leukocyte count and/or CSF/blood glucose ratio. 4,12,15 However, pleocytosis may be caused by aseptic meningitis, viral meningitis, or possibly even prolonged convulsions. 16 Furthermore, proven bacterial meningitis may present with clear CSF and a low CSF leukocyte count.…”

“…We found no evidence that signs compatible with lower respiratory tract infection influenced the chances of meningitis, as has been reported elsewhere. 4,15 In a study of Nigerian infants who were Ͻ6 months, old, 41% of meningitis cases were reported to have a coexisting lower respiratory tract infection. 17 We therefore think that signs of lower respiratory tract infection should not bias clinicians against investigating and/or treating for meningitis when other indicators exist.…”

Predictors of Acute Bacterial Meningitis in Children from a Malaria-Endemic Area of Papua New Guinea

“…In studies from the highlands of Papua New Guinea, where there is no malaria transmission 8 and from countries in Africa with holo-endemic Plasmodium falciparum malaria, 9,15 neck stiffness and a bulging fontanel were independently associated with ABM. Other features such as refusal to eat, staring eyes, and convulsions were inconsistent associates.…”

“…[5][6][7][8] Diagnosis and management can therefore be challenging, 9 especially when young children with ABM present with non-specific features, including lethargy or irritability rather than the classic clinical signs of meningeal irritation. 10 In malaria-endemic areas, the symptoms and signs of severe malarial illness can overlap with those of ABM, further complicating assessment.…”