Predictors of Acute Bacterial Meningitis in Children from a Malaria-Endemic Area of Papua New Guinea

Laman, Moses; Manning, Laurens; Greenhill, Andrew R.; Mare, Trevor; Michael, Audrey; Shem, Silas; Vince, John; Lagani, William; Hwaiwhanje, Ilomo; Siba, Peter; Müeller, Ivo; Davis, Timothy M. E.

doi:10.4269/ajtmh.2012.11-0312

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…All hospitalized children aged between 2 months and 10 years who presented with febrile seizures, impaired consciousness, coma or other clinical signs and symptoms suggestive of a possible CNS infection were screened for inclusion. A standardized case report form that included demographic and clinical data was completed [ 14 ], including details of the presenting illness, characteristics of seizures, vaccination history and past medical history. Trained research nurses and study clinicians carried out clinical assessment on admission.…”

Section: Methodsmentioning

confidence: 99%

Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea

Laman

Hwaiwhanje²,

Bona

et al. 2014

BMC Infect Dis

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BackgroundViral central nervous system (CNS) infections are common in countries where malaria is endemic but, due to limited laboratory facilities, few studies have systematically examined the prevalence and clinical consequences of the presence of viruses in cerebrospinal fluid (CSF) from children with suspected CNS infection.MethodsWe performed a prospective study of Papua New Guinean children hospitalized with signs and symptoms of CNS infection. CSF samples from 300 children without proven bacterial/fungal meningitis were analyzed for human herpes viruses (HHV), picornaviruses, influenza, adenoviruses, flaviviruses and bacteria.ResultsFifty-five children (18%) had viral (42), bacterial (20) or both viral and bacterial (7) nucleic acids (NA) identified in their CSF. Human herpes viruses accounted for 91% of all viruses found. The identification of viral or bacterial NA was not associated with any characteristic clinical features. By contrast, malaria was associated with increased identification of viral and bacterial NA and with impaired consciousness, multiple convulsions and age. Malaria was also inversely associated with an adverse outcome. Amongst children with HHV infection, those with HHV-6 and −7 were younger, were more likely have impaired consciousness and had a higher proportion of adverse outcomes than children with CMV. Dengue and enteroviral infections were infrequent. Adenoviral and influenza infections were not identified.ConclusionInfections with HHV-6, HHV-7, dengue and enterovirus have the potential to cause serious CNS disease in young PNG children. However most HHVs in this malaria-endemic setting should be considered to be the result of reactivation from a latent reservoir without clinical sequelae.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0630-0) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea

Laman

Hwaiwhanje²,

Bona

et al. 2014

BMC Infect Dis

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“…[10] Data from India are limited to a retrospective study, where the prevalence of meningitis was 2.4% in children with first febrile seizures, 0.86% in simple febrile seizures, and 4.81% in complex febrile seizures. [3] In [12] According to AAP, febrile convulsions are associated with a temperature ≥100.4°C. In clinical practice, we have observed that children with meningitis usually have a high-grade fever.…”

Section: Discussionmentioning

confidence: 99%

Predictors of acute bacterial meningitis among children with a first episode of febrile convulsion from Northern India: A prospective study

Singh¹,

Silayach²,

Gathwala³

et al. 2014

Ann Trop Med Public Health

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Context:There is limited data to support need of lumbar puncture among Indian children aged less than 5 years presenting with a first episode of fever and seizure. Aims: To determine the incidence and clinical predictors of meningitis among children aged 6-60 months presenting with a first episode of febrile convulsion. Settings and Designs: A prospective study was conducted on 35 children (6-60 months) with a first episode of febrile convulsion subjected to lumbar puncture in a tertiary care teaching hospital of North India. Materials and Methods: Clinical characteristics were compared between the two groups: Children with meningitis (n = 17) and children without meningitis (n = 18). Statistical Methods: Multivariate logistic regression was applied to assess the independent predictors of meningitis. Results: A total of 120 children were screened; 35 children subjected to lumbar puncture were finally enrolled. The mean (SD) age of enrolled children was 18.49 (10.79) months. The incidence of meningitis was 48.6% (17/35). Children with meningitis significantly had a higher proportion of children with high grade (temperature >104°F) fever (P = 0.005), received prior antibiotics (P = 0. 041), had lower hemoglobin levels (P = 0.04) and lower blood sugar levels (P = 0.03) as compared to children with no meningitis. On multivariate logistic regression, it was observed that high-grade fever was an independent predictor of meningitis (odds ratio: 0.03 [0.001-0.86] [P = 0.04]). Conclusion: We found that the presence of high-grade fever was an important predictor of meningitis among children aged 6-60 months presenting with a first episode of febrile convulsion.

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“…The present analysis also shows that although the specificity of KCH-2002 signs excluding fever without malaria parasitaemia has not changed, sensitivity was again markedly reduced (to 58% from 86%). Malaria parasitaemia has been shown to augment predictive models for bacterial meningitis [11,29]; however, the significant morbidity and mortality associated with meningitis means a screening rule with higher sensitivity may be favourable despite lower specificity.…”

Section: Discussionmentioning

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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Predictors of Acute Bacterial Meningitis in Children from a Malaria-Endemic Area of Papua New Guinea

Cited by 9 publications

References 26 publications

Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea

Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea

Predictors of acute bacterial meningitis among children with a first episode of febrile convulsion from Northern India: A prospective study

Clinical features of bacterial meningitis among hospitalised children in Kenya

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