Clinical features of bacterial meningitis among hospitalised children in Kenya

BMC Medicine

Neema Mturi¹  Christina W. Obiero²  Charles R. Newton³  Moses Ngari⁴  James A. Berkley⁵  Michaël Boele van Hensbroek⁶  Salim Mwarumba⁷ 

[1] Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya;Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya;Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands;Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya;Department of Psychiatry, University of Oxford, Oxford, UK;Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya;The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya;Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya;The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya;Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands;Department of Microbiology, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya;

关键词: Meningitis;    Children;    Clinical features;    Signs;    Lumbar puncture;    Cerebrospinal fluid;    Conjugate vaccines;    Low- and middle-income countries;   

DOI  :  10.1186/s12916-021-01998-3

来源: Springer

【 摘 要 】

BackgroundDiagnosing 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.MethodsWe 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.ResultsAmong 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).ConclusionsA 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.

【 授权许可】

CC BY