Empiric treatment of acute meningitis syndrome in a resource-limited setting: Clinical outcomes and predictors of survival or death

Tadesse, Birkneh Tilahun; Foster, Byron A.; Shibeshi, Mulugeta Sitot; Tadele, Henok

doi:10.4314/ejhs.v27i6.3

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…The previous data of the numerical effect of growth failure on increasing deaths in BM is scarce and based on slightly different definitions. In Ethiopia 28 , severe wasting (= weight-for-height z-score [WHZ] < − 3, indicating acute undernutrition) increased BM deaths 2.8 times (95% CI 1.1–7.7), which is similar to our odds in Angola of 1.92 (95% CI 1.21–3.04) for severe underweight (WAZ < − 3). In Peru, “malnutrition”, not defined in more detail, significantly ( p = 0.03) increased deaths 29 .…”

Section: Discussionsupporting

confidence: 81%

Importance of underweight in childhood bacterial meningitis in Finland, Latin America and Angola

Roine

Kallio

Peltola

et al. 2022

Sci Rep

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Our objective was to explore the importance of underweight on the course of childhood bacterial meningitis (BM) at different study sites, because prior studies showed discrepant results. Using directly comparable, prospective data from three continents, weight-for-age z-scores (WAZ) were determined by WHO Anthro programs in children with BM in Finland (N = 318), LatAm (N = 580), and Angola (N = 780) and compared with data describing the admission, course, and outcome of BM. WAZ < –1 indicates underweight; either mild (< –1 to –2), moderate (< –2 to –3), or severe (< –3). The mean WAZ (SD) was 0.17 (1.17), –0.42 (1.53), and –1.36 (1.44), and the prevalence of moderate-severe underweight 2.8%, 12.6%, and 31.3%, in Finland, LatAm, and Angola, respectively. In univariate analysis, LatAm and Angola showed an association between lower WAZ and poorer condition on admission, slower recovery, and more deaths. In Finland, infrequent underweight limited meaningful analysis. In multivariate analysis of different variables for increasing the odds of death, severe underweight had lower odds compared to disease severity in Angola, but highest in LatAm. Thus, the apparent discrepancy in underweights´ importance for increasing deaths varied from primary to more secondary according to locally more prominent risks.

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Section: Discussionsupporting

confidence: 81%

Importance of underweight in childhood bacterial meningitis in Finland, Latin America and Angola

Roine

Kallio

Peltola

et al. 2022

Sci Rep

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“…Many cases of acute infection, including meningitis and sepsis, are managed in the absence of a specific pathogen diagnosis in both high-and low-resource settings [1][2][3][4][5] . The primacy of empirical therapy reflects clinical urgency combined with the complexity of the testing landscape for acute conditions, a lack of assay sensitivity, and the time required to run a series of tests.…”

Section: Introductionmentioning

confidence: 99%

Targeted metagenomic sequencing enhances the identification of pathogens associated with acute infection

Goh

Golubchik

Ansari

et al. 2019

Preprint

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The routine identification of pathogens during infection remains challenging because it relies on multiple modalities such as culture and nucleic acid amplification and tests that tend to be specific for very few of an enormous number of possible infectious agents. Metagenomics promises single-test identification, but shotgun sequencing remains unwieldy and expensive or in many cases insufficiently sensitive to detect the amount of pathogen material in a clinical sample. Here we present the validation and application of Castanet, a method for metagenomic sequencing with enrichment that exploits clinical knowledge to construct a broad panel of relevant organisms for detection at low cost with sensitivity comparable to PCR. Castanet targets both DNA and RNA, works with small sample volumes, and can be implemented in a high-throughput diagnostic setting. We used Castanet to analyse plasma samples from 573 patients from the GAinS sepsis cohort and CSF samples from 243 patients from the ChiMES meningitis cohort that had been evaluated using standard clinical microbiology methods, identifying relevant pathogens in many cases where no pathogen had previously been detected. Castanet is intended for use in defining the distribution of pathogens in samples, diseases and populations, for large-scale clinical studies and for verifying the performance of routine testing regimens. By providing sequence as output, Castanet combines pathogen identification directly with subtyping and phylo-epidemiology.

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“…We lacked data on pre-hospital antibiotic exposure which may be common and has been shown to alter CSF leukocyte count and biochemical profile and impede detection of bacterial pathogens [5,35]. Diagnostic delay may decrease survival [36] and increase neurological sequelae in Hib meningitis [37] and may be more of a problem in settings without advanced diagnostic resources such as CSF polymerase chain reaction (PCR) [38].…”

Section: Limitationsmentioning

confidence: 99%

Clinical features of bacterial meningitis among hospitalised children in Kenya

Obiero

Mturi

Mwarumba

et al. 2021

BMC Med

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Background Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days. Methods We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1. Results Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77–92) and specificity of 38% (95% CI 37–38). Exclusion of ‘fever without malaria parasitaemia’ reduced sensitivity to 58% (95% CI 48–68) and increased specificity to 80% (95% CI 79–80). IMCI signs had a sensitivity of 80% (95% CI 70–87) and specificity of 62% (95% CI 61–63). Conclusions A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.

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Empiric treatment of acute meningitis syndrome in a resource-limited setting: Clinical outcomes and predictors of survival or death

Cited by 8 publications

References 17 publications

Importance of underweight in childhood bacterial meningitis in Finland, Latin America and Angola

Importance of underweight in childhood bacterial meningitis in Finland, Latin America and Angola

Targeted metagenomic sequencing enhances the identification of pathogens associated with acute infection

Clinical features of bacterial meningitis among hospitalised children in Kenya

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