TITLE:
Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh
AUTHORS:
Farzana Afroze, Tahmeed Ahmed, Shafiqul Alam Sarker, Abu S. G. Faruque, Hasan Ashraf, Pradip Kumar Bardhan, Sumon Kumar Das, Mohammod Jobayer Chisti
KEYWORDS:
Children; Diarrhea; Hypoxemia; Meningitis; Neutrophilia; Peripheral Pulse
JOURNAL NAME:
Food and Nutrition Sciences,
Vol.5 No.2,
January
20,
2014
ABSTRACT:
Background: Data are lack on predicting features
of meningitis in diarrheal children although the great
clinical importance. Objective: To evaluate clinical and laboratory features in
predicting meningitis in under-fifteen children having diarrheal illnesses.
Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka
Hospital of icddr, b between
March 2011 and February 2012 with fever and seizure or altered consciousness
and having LP done were enrolled
into this analysis. Those children who had abnormal CSF findings [pleocytosis
(normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal
range, 0.10 - 0.45 mg/dl) and low
glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between
children with (cases = 17) and without meningitis (controls = 66) from our
study children. Data were retrospectively collected from SHEBA, an online
database system of the Dhaka Hospital of icddr, b. Results: Death was
significantly higher among the cases compared to the controls (29% vs. 3%, p =
0.003). In logistic regression analysis, after
adjusting for potential confounders, cases frequently had hypoxemia (95% CI
1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and
neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children
with meningitis had higher case fatality rate. Simple independent predictors of
meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may
help clinicians to initiate early and prompt management in order to curve
lifelong sequel due to meningitis and death in such patient population
especially those in resource poor settings.