Clinical profile and outcome of children with acute bacterial meningitis in a tertiary care centre in eastern Nepal

Abstract

Background: Bacterial meningitis is a severe infection of the central nervous system with varied clinical presentations. It is associated with substantial mortality and morbidity. Objectives: The objective of this study was to assess the clinical profile, including the clinical features, laboratory and radiological parameters, clinical course, treatment, response to treatment, complications, and outcome of children at discharge. Methods: A prospective observational study was conducted among 52 inpatient children of acute bacterial meningitis aged one month to 14 years over a period of six months. The patients were enrolled during admission and followed up daily till discharge. Socio-demographic, clinical, and diagnostic details and outcomes were recorded and analysed using statistical package for social sciences version 20. Results: The median age of the patients was two years with male to female ratio of 2:1. Fever (45, 87%), vomiting (37, 71%), seizure (33, 64%) and headache (22, 46%) were the most common symptoms. The cerebrospinal fluid culture was positive in three (6%) cases. Complications were seen in 20 (39%) patients including four (7.7%) deaths. Patients with prolonged fever, malnutrition, loss of consciousness, ear discharge, presence of meningeal signs, abnormal pupil, high cerebrospinal fluid protein, positive cerebrospinal fluid, and blood culture, low blood pH, and hyperlactataemia were significantly associated with complications (p <0.05). Conclusion: Factors like malnutrition, longer duration of fever, and abnormal neurological and laboratory findings were associated with higher rates of complications.

Unusual Gram‐negative bacteria cause more severe bacterial meningitis than the three classical agents in children

“…Gram-negative organisms, classical and nonclassical, contributed the majority (72%) of cases of childhood BM in a small series (N 18) in Nepal, 22 whereas no difference to Grampositives prevailed in a more recent study (N 52) from the same country. 23 Concerning the variables associated with nonclassical BM (Table 3), our most reliable results come from Angola with most pa- Once H. influenzae type b, pneumococcal and meningococcal vaccines become available, approximately a 90% reduction in childhood BM is possible. Now that the role of these three agents is diminishing, the role of nonclassical agents is growing.…”

“…Salmonellae , but not Klebsiellae or Protei, were fairly frequently detected also in LatAm, being totally nonexistent in our series from Finland (Figure 1). Gram‐negative organisms, classical and nonclassical, contributed the majority (72%) of cases of childhood BM in a small series (N 18) in Nepal, 22 whereas no difference to Gram‐positives prevailed in a more recent study (N 52) from the same country 23 …”

Sociopolitical Dimensions of English in Nepal

“…The universities require English, along with Nepali, as compulsory subjects and English remains the medium of instruction in science, medicine and technical subjects. The plan to switch over to Nepali as the exclusive medium of higher education in the humanities and social sciences by 1980 had to be abandoned for lack of adequate learning materials in Nepali (Bhatta, 1987).…”