Bacterial Meningitis in Infants

Abstract

SYNOPSIS Neonatal bacterial meningitis is an uncommon but devastating infection. Although the incidence and mortality have declined over the last several decades, morbidity among survivors remains high. The types and distribution of causative pathogens are related to birth gestational age, postnatal age, and geographic region. Confirming the diagnosis of meningitis can be difficult. Clinical signs are often subtle, and the lumbar puncture is frequently deferred in clinically unstable infants. When obtained, confirmatory testing with cerebrospinal fluid (CSF) culture is often compromised by antepartum or postnatal antibiotic exposure. While blood cultures and CSF parameters may be helpful in cases where the diagnosis is uncertain, bacterial meningitis occurs in infants without bacteremia and with normal CSF parameters. Newer tests such as the polymerase chain reaction are promising but require further study. Prompt treatment with appropriate antibiotics is essential to optimize outcomes. Successful efforts to prevent meningitis in infants have included the use of intrapartum antibiotic prophylaxis against Group B Streptococcus (GBS). Clinical trials investigating the use of a GBS vaccine for the prevention of neonatal GBS disease are ongoing.

Meningitis neonatal en un hospital general de Lima, Perú, 2008 al 2015

“…Aún persiste controversia con respecto al punto de corte para definir MN temprana y tardía; algunos refieren el corte en 3 días (2,4) , otros en 7 días (1,6,9) y otros consideran puntos variables (5) . En este estudio, la mediana de edad de diagnóstico en los casos tempranos fue un día y en los tardíos fue de 11 días.…”

“…La incidencia mundial oscila entre 0,8 y 6,1 casos por mil nacidos vivos y, en el Perú, dos series la describen entre 0,5 y 0,9 casos por mil nacidos vivos (1)(2)(3)(4) . La letalidad es elevada: 10% en países desarrollados y 40-58% en países en desarrollo (3) .…”

Neonatal Sepsis

“…Longer duration of therapy is recommended in complicated cases or for delayed clinical improvement [60]. Consultation with a pediatric infectious disease specialist is warranted for cases that are complicated by meningitis.…”

Laboratory Diagnosis of Central Nervous System Infection

“…CSF viral, bacterial (including mycobacterial) and fungal cultures remain the main stay in the diagnosis of infectious meningitis. However, the yield of CSF cultures in suspected cases is low 28 . Another disadvantage of CSF bacterial culture is that it requires up to 72 hours for final identification.…”