Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh

DOI: 10.4236/fns.2014.52022   PDF   HTML     3,971 Downloads   5,316 Views   Citations

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.

Share and Cite:

F. Afroze, T. Ahmed, S. Sarker, A. Faruque, H. Ashraf, P. Bardhan, S. Das and M. Chisti, "Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh," Food and Nutrition Sciences, Vol. 5 No. 2, 2014, pp. 169-176. doi: 10.4236/fns.2014.52022.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. W. Weber, J. Herman, S. Jaffar, S. Usen, A. Oparaugo, C. Omosigho, R. A. Adegbola, B. M. Greenwood and E. K. Mulholland, “Clinical Predictors of Bacterial Meningitis in Infants and Young Children in the Gambia,” Tropical Medicine & International Health, TM & IH, Vol. 7, No. 9, 2002, pp. 722-731.
http://dx.doi.org/10.1046/j.1365-3156.2002.00926.x
[2] L. Liu, H. L. Johnson, S. Cousens, J. Perin, S. Scott, J. E. Lawn, I. Rudan, H. Campbell, R. Cibulskis, M. Li, et al., “Global, Regional, and National Causes of Child Mortality: An Updated Systematic Analysis for 2010 with Time Trends since 2000,” Lancet, Vol. 379, No. 9832, 2012, pp. 2151-2161.
http://dx.doi.org/10.1016/S0140-6736(12)60560-1
[3] S. Curtis, K. Stobart, B. Vandermeer, D. L. Simel and T. Klassen, “Clinical Features Suggestive of Meningitis in Children: A Systematic Review of Prospective Data,” Pediatrics, Vol. 126, No. 5, 2010, pp. 952-960.
http://dx.doi.org/10.1542/peds.2010-0277
[4] WHO, “The Global Burden of Disease 2004 Update,” WHO, Geneva, 2004.
[5] J. M. Fellick and A. P. Thomson, “Long-Term Outcomes of Childhood Meningitis,” Hospital Medicine, Vol. 63, No. 5, 2002, pp. 274-277.
[6] B. V. Bhat, I. C. Verma, R. K. Puri, S. Srinivasan and P. Nalini, “A Profile of Pyogenic Meningitis in Children,” Journal of the Indian Medical Association, Vol. 89, No. 8, 1991, pp. 224-227.
[7] W. A. Kennedy, S. J. Chang, K. Purdy, T. Le, P. E. Kilgore, J. S. Kim, D. D. Anh, P. L. Huong, B. Q. Dong, D. M. Tan, et al., “Incidence of Bacterial Meningitis in Asia Using Enhanced CSF Testing: Polymerase Chain Reaction, Latex Agglutination and Culture,” Epidemiology and Infection, Vol. 135, No. 7, 2007, pp. 1217-1226.
http://dx.doi.org/10.1017/S0950268806007734
[8] M. J. Chisti, A. S. Faruque, W. A. Khan, S. K. Das, M. B. Zabed and M. A. Salam, “Characteristics of Children with Shigella Encephalopathy: Experience from a Large Urban Diarrhea Treatment Center in Bangladesh,” The Pediatric Infectious Disease Journal, Vol. 29, No. 5, 2010, pp. 444447. http://dx.doi.org/10.1097/INF.0b013e3181cb4608
[9] N. H. Solomon, S. Lavie, B. L. Tenney and M. J. Blaser, “Campylobacter Enteritis Presenting with Convulsions,” Clinical Pediatrics, Vol. 21, No. 2, 1982, pp. 118-119.
http://dx.doi.org/10.1177/000992288202100209
[10] M. J. Chisti, P. K. Bardhan, S. Huq, W. A. Khan, A. M. Khan, Sharifuzzaman and M. A. Salam, “High-Dose Intravenous Dexamethasone in the Management of Diarrheal Patients with Enteric Fever and Encephalopathy,” The Southeast Asian Journal of Tropical Medicine and Public Health, Vol. 40, No. 5, 2009, pp. 1065-1073.
[11] J. Arii, Y. Tanabe, M. Miyake, M. Noda, Y. Takahashi, H. Hishiki and Y. Kohno, “Acute Encephalopathy Associated with Nontyphoidal Salmonellosis,” Journal of child neurology, Vol. 16, No. 7, 2001, pp. 539-540.
http://dx.doi.org/10.1177/088307380101600718
[12] L. A. Kestenbaum, J. Ebberson, J. J. Zorc, R. L. Hodinka and S. S. Shah, “Defining Cerebrospinal Fluid White Blood Cell Count Reference Values in Neonates and Young Infants,” Pediatrics, Vol. 125, No. 2, 2010, pp. 257-264.
http://dx.doi.org/10.1542/peds.2009-1181
[13] M. J. Chisti, M. A. Pietroni, J. H. Smith, P. K. Bardhan and M. A. Salam, “Predictors of Death in Under-Five Children with Diarrhoea Admitted to a Critical Care Ward in an Urban Hospital in Bangladesh,” Acta Paediatrica, Vol. 100, No. 12, 2011, pp. e275-279.
http://dx.doi.org/10.1111/j.1651-2227.2011.02368.x
[14] T. Duke, A. J. Blaschke, S. Sialis and J. L. Bonkowsky, “Hypoxaemia in Acute Respiratory and Non-Respiratory Illnesses in Neonates and Children in a Developing country,” Archives of Disease in Childhood, Vol. 86, No. 2, 2002, pp. 108-112. http://dx.doi.org/10.1136/adc.86.2.108
[15] J. B. West, “Respiratory Physiology: The Essentials,” Lippincort Williams and Wilkins, Philadelphia, 2008.
[16] G. J. Ebrahim, “Sepsis, Septic Shock and the Systemic Inflammatory Response Syndrome,” Journal of Tropical Pediatrics, Vol. 57, No. 2, 2011, pp. 77-79.
http://dx.doi.org/10.1093/tropej/fmr022
[17] S. Aneja and A. Aggarwal, “Acute Bacterial Meningitis,” Indian Pediatrics, Vol. 34, No. 12, 1997, pp. 1097-1109.
[18] I. Ansari and Y. Pokhrel, “Culture Proven Bacterial Meningitis in Children: Agents, Clinical Profile and Outcome,” Kathmandu University Medical Journal, Vol. 9, No. 33, 2011, pp. 36-40.
[19] R. M. Close, O. O. Ejidokun, N. Q. Verlander, G. Fraser, M. Meltzer, Y. Rehman, P. Muir, N. Ninis and J. M. Stuart, “Early Diagnosis Model for Meningitis Supports Public Health Decision Making,” The Journal of Infection, Vol. 63, No. 1, 2011, pp. 32-38.
http://dx.doi.org/10.1016/j.jinf.2011.03.013
[20] M. A. Babiker and S. A. Taha, “Meningitis in Children of Riyadh,” The Journal of Tropical Medicine and Hygiene, Vol. 87, No. 6, 1984, pp. 245-248.
[21] B. Sigauque, A. Roca, S. Sanz, I. Oliveiras, M. Martinez, I. Mandomando, X. Valles, M. Espasa, F. Abacassamo, J. Sacarlal, et al., “Acute Bacterial Meningitis among Children, in Manhica, a Rural Area in Southern Mozambique,” Acta Tropica, Vol. 105, No. 1, 2008, pp. 21-27.
http://dx.doi.org/10.1016/j.actatropica.2007.01.006
[22] M. J. Chisti, T. Duke, C. F. Robertson, T. Ahmed, A. S. Faruque, H. Ashraf, S. La Vincente, P. K. Bardhan and M. A. Salam, “Clinical Predictors and Outcome of Hypoxaemia among Under-Five Diarrhoeal Children with or without Pneumonia in an Urban Hospital, Dhaka, Bangladesh,” Tropical Medicine & International Health: TM & IH, Vol. 17, No. 1, 2012, pp. 106-111.
http://dx.doi.org/10.1111/j.1365-3156.2011.02890.x
[23] T. Gustot, “Multiple Organ Failure in Sepsis: Prognosis and Role of Systemic Inflammatory Response,” Current Opinion in Critical Care, Vol. 17, No. 2, 2011, pp. 153159.
http://dx.doi.org/10.1097/MCC.0b013e328344b446
[24] M. J. Chisti, S. Saha, C. N. Roy, T. Ahmed, A. S. Faruque, M. A. Salam and S. Islam, “Predictors of Mortality in Infants with Sclerema Presenting to the Centre for Diarrhoeal Disease, Dhaka,” Annals of Tropical Paediatrics, Vol. 29, No. 1, 2009, pp. 45-50.
http://dx.doi.org/10.1179/146532809X402024
[25] J. Brierley, J. A. Carcillo, K. Choong, T. Cornell, A. Decaen, A. Deymann, A. Doctor, A. Davis, J. Duff, M. A. Dugas, et al., “Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2007 Update from the American College of Critical Care Medicine,” Critical Care Medicine, Vol. 37, No. 2, 2009, pp. 666-688.
http://dx.doi.org/10.1097/CCM.0b013e31819323c6
[26] WHO, “Pocket Book for Hospital Care of Children: Guidelines for the Management of Common Illness with Limited Resources,” WHO, Geneva, 2005.
[27] C. M. Waruiru, C. R. Newton, D. Forster, L. New, P. Winstanley, I. Mwangi, V. Marsh, M. Winstanley, R. W. Snow and K. Marsh, “Epileptic Seizures and Malaria in Kenyan Children,” Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 90, No. 2, 1996, pp. 152-155.
http://dx.doi.org/10.1016/S0035-9203(96)90120-0
[28] J. A. Berkley, A. C. Versteeg, I. Mwangi, B. S. Lowe and C. R. Newton, “Indicators of Acute Bacterial Meningitis in Children at a Rural Kenyan District Hospital,” Pediatrics, Vol. 114, No. 6, 2004, pp. e713-e719.
http://dx.doi.org/10.1542/peds.2004-0007
[29] C. M. Norris, P. G. Danis and T. D. Gardner, “Aseptic Meningitis in the Newborn and Young Infant,” American Family Physician, Vol. 59, No. 10, 1999, pp. 2761-2770.
[30] L. E. Nigrovic, R. Malley, C. G. Macias, J. T. Kanegaye, D. M. Moro-Sutherland, R. D. Schremmer, S. H. Schwab, D. Agrawal, K. M. Mansour, J. E. Bennett, et al., “Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children with Bacterial Meningitis,” Pediatrics, Vol. 122, No. 4, 2008, pp. 726-730.
http://dx.doi.org/10.1542/peds.2007-3275
[31] E. S. Gurley, M. J. Hossain, S. P. Montgomery, L. R. Petersen, J. J. Sejvar, L. W. Mayer, A. Whitney, P. Dull, N. Nahar, A. K. Uddin, et al., “Etiologies of Bacterial Meningitis in Bangladesh: Results from a Hospital-Based Study,” The American Journal of Tropical Medicine and Hygiene, Vol. 81, No. 3, 2009, pp. 475-483.
[32] N. H. Alam and H. Ashraf, “Treatment of Infectious Di-arrhea in Children,” Paediatric Drugs, Vol. 5, No. 3, 2003, pp. 151-165.
[33] WHO, “Training Course on Child Growth Assessment,” WHO, Geneva, 2008.
[34] R. E. Behrman, R. M. Kliegman and H. B. Jenson, “Nelson Textbook of Pediatrics,” 19th Edition, W.B. Saunders Company, Philadelphia, 2011.
[35] R. P. Dellinger, M. M. Levy, J. M. Carlet, J. Bion, M. M. Parker, R. Jaeschke, K. Reinhart, D. C. Angus, C. BrunBuisson, R. Beale, et al., “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008,” Critical Care Medicine, Vol. 36, No. 1, 2008, pp. 296-327.
http://dx.doi.org/10.1097/01.CCM.0000298158.12101.41

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.