Outcome and prognostic factors of acute meningoencephalitis in children of Southern Bangladesh

Abstract

Objective: To estimate the outcome of acute meningoencephalitis (AME) in children and evaluate the impact of prognostic factors. Design and setting:A prospective cross sectional study was conducted in the paediatric ward of Khulna Medical College Hospital from 2007-2009. Method:All admitted children, aged 1 month to 12 years, satisfying the case definition were enrolled into the study. Cerebrospinal fluid (CSF) was collected for cytology and biochemistry to categorize AME into pyogenic, viral or normal varieties. CSF was tested for common bacterial antigen and, along with serum was also tested for Japanese encephalitis virus antibodies. Patients were monitored twice daily until the final outcome.Results: One hundred and forty children were inducted constituting 2.5% of admissions. Infants (30%) were the worst sufferers. Twenty one (15%) children with AME died which is 4 times higher than the overall mortality (3.8%) in paediatric ward (p<0.001). Among the 11 bacteria positive cases one died from S Pneumoniae. Low GCS score was associated with higher mortality (p<0.05). Eighteen (13%) cases developed neurological sequelae. Paralysis (27%) was the most frequent followed by hydrocephalus (23%) and involuntary movements (14%). Number of sequelae was significantly higher in pyogenic (44%) meningoencephalitis in comparison to non-pyogenic (14%) Conclusions: Mortality from AME was 15%. Low GCS score was associated with higher fatality.

Pattern and Outcome of Central Nervous System Infections in Suez Governorate

“…In our study most affected age group was children; these data are in agreement with many previous literature which detect that children are the most vulnerable group to CNS infection [15,17]. Also males are more affected than females which in agreement with Rantakallio et al who mentioned that 63% of patients in this cohort study in Finland were male [18].…”

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

“…22 Similarly the incidence of brain abscess (1, 1.9%) was lower in this study, as was the finding made by Rasul et al (4%). 13 However, the patients with cerebral oedema, as demonstrated in CT head were higher in this study (10, 19.2%) as compared to the observations of Rasul et al (8.3%). 13 Also, the proportion of patients having haemorrhage on CT head, in this study were comparable to the study of Ciofi degli Atti et al 21 The proportion of patients with abnormality in CT scan head might be due to two reasons, first being the early introduction of systemic antibiotics leading to a lesser number of complications; the second being the lesser number of patients in whom CT scan head was done, may be due to financial or logistic reasons.…”

“…13 However, the patients with cerebral oedema, as demonstrated in CT head were higher in this study (10, 19.2%) as compared to the observations of Rasul et al (8.3%). 13 Also, the proportion of patients having haemorrhage on CT head, in this study were comparable to the study of Ciofi degli Atti et al 21 The proportion of patients with abnormality in CT scan head might be due to two reasons, first being the early introduction of systemic antibiotics leading to a lesser number of complications; the second being the lesser number of patients in whom CT scan head was done, may be due to financial or logistic reasons. In this study, there was a higher incidence of sepsis, Disseminated Intravascular Coagulation (DIC), and nosocomial infection (15.4%, 5.8%, and 7.7%) as compared to the findings of Ciofi degli Atti et al ( 3.5%, 5.9%, and 1.2%).…”

“…There was a male preponderance in this study, and the majority of the children belonged to the under five year age group, a finding similar to other studies. [10][11][12][13] However, in a study done by Shrestha et al the majority of children were above five years of age. 14 The reason behind the higher prevalence of meningitis in younger children could be a lower immunity and incomplete immunisation series in this age group.…”

“…Different studies have reported wide variation in the occurrence of neurologic complications from 8.5% to 42%. 12,13,21,23 However, we estimated the inhospital complications only, and could not follow the patients' post-discharge. This could have underestimated the actual complication rate.…”