Pattern of Childhood Meningitis; Diagnosis and Treatment

Abstract

Acute bacterial meningitis is a medical emergency requiring immediate diagnosis and treatment. Streptococcus
pneumoniae and Neisseria meningitis are the most common and most aggressive pathogens of meningitis.
Twenty four of forty four patients admitted with suspected meningitis had fulfilled criteria of the disease, their age
ranged between 50 days and 12 years. Twelve of them were males with male: female ratio 1:1. All laboratory
investigations were done as a part of the daily routine work. Most patients presented with fever and vomiting.
Headache was common at and after 4 years of age. From 24 patients with meningitis 79% were pyogenic and
21% were aseptic. CSF culture demonstrated the growth of one organism like E.coli, Enterobacter cloacae, Gram
negative diplococci, Streptococcus pneumniae and klebsiella pneumonia. Brain images (CT scan or MRI) showed
presence of complication such as brain abscess, subdural collections and dilatation of ventricles in 4 patients.
The classical symptoms and signs of bacterial meningitis may be absent. A high index of suspicions for bacterial
meningitis in the child with convulsion and fever is paramount. The most appropriate management is a lumbar
puncture, when there are no contraindications, analyzing CSF and to start immediately parenteral antibiotics. When
the results of the cerebrospinal fluid (CSF) culture and susceptibilities are known, therapy can be narrowed to
cover the specific pathogen identified. In general, Penicillin G or Ampicillin is preferred for group B streptococcal
meningitis, Ampicillin for Listeria monocytogenes meningitis, and Ampicillin plus either an Aminoglycoside or
Cefotaxime for Gram negative meningitis.