Bacterial meningitis in children : Critical care needs

Abstract

Acute bacterial meningitis (ABM) in children is associated with a high rate of acute complications and mortality, particularly in the developing countries. Most of the deaths occur during first 48 hours of hospitalization. Coma, raised intracranial pressure (ICP), seizures, shock have been identified as significant predictors of death and morbidity. This article reviews issues in critical care with reference to our experience of managing 88 children with ABM in PICU. Attention should first be directed toward basic ABCs of life-support. Children with Glasgow Coma Scale (GSC) score < 8 need intubation and supplemental oxygen. Antibiotics should be started, even without LP (contraindicated if focal neuro-deficit, papilledema, or signs of raised ICP). Raised ICP is present in most of patients; GCS < 8 and high blood pressure are good guides. Mannitol (0.25 gm/Kg) should be used in such patients. If there are signs of (impending) herniation short-term hyperventilation is recommended; prolonged hyperventilation (> 1 hour) must be avoided. Any evidence of poor perfusion, hypovolemia and/or hypotension needs aggressive treatment with normal saline boluses and inotropes, if necessary, to maintain normal blood pressure. Empiric fluid restriction is not justified. Seizures may be controlled with intravenous diazepam or lorazepam. Refractory status epilepticus may be treated with continuous diazepam (0.01-0.06) mg/kg/min) or midazolam infusion. Ventilatory support may be needed early for associated pneumonia, poor respiratory effort and/or coma, and occasionally to reduce work of breathing in shock. Provision of critical care to children with ABM may reduce the mortality significantly as experienced by us.

Subtype distribution of Haemophilus influenzae isolates from North India

“…H. influenzae type b is a leading cause of bacterial meningitis and other invasive infections in childhood world-wide. In India, the annual incidence of Hib meningitis has been quite high and results in severe morbidity and mortality in children ,5 years of age [5,6]. In the present investigation also, 24% (73 of a total 305) of the CSF and 10% (4 of 41) of the total blood samples screened were found to be positive for H. influenzae serotype b, which indicates a high prevalence of Hib-associated meningitis.…”

“…In India, 96% of all haemophilus infections are caused by H. influenzae serotype b (Hib) [5]. Since the mid1950s, Hib has been the most common cause of pyogenic meningitis in children in India.…”

Rapid detection of Haemophilus influenzae by hel gene polymerase chain reaction

“…These results are in congruence with previous reports from north India (Bahl et al. 1995; Singhi et al. 2001).…”

“…However, no correlation could be established between the serotypes and biotypes of H. influenzae. These results are in congruence with previous reports from north India (Bahl et al 1995;Singhi et al 2001).…”

Protein conjugate polysaccharide vaccines: Challenges in development and global implementation

“…In India, the burden of morbidity and mortality caused by these bacteria are as high as 60–100% among children under 5 years. (7–13) Studies show increased prevalence of multidrug resistant strains in India and other developing countries. (10111415)…”