Volume 86, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Predictors of acute bacterial meningitis (ABM) were assessed in 554 children in Papua New Guinea 0.2–10 years of age who were hospitalized with culture-proven meningitis, probable meningitis, or non-meningitic illness investigated by lumbar puncture. Forty-seven (8.5%) had proven meningitis and 36 (6.5%) had probable meningitis. Neck stiffness, Kernig’s and Brudzinski’s signs and, in children < 18 months of age, a bulging fontanel had positive likelihood ratios (LRs) ≥ 4.3 for proven/probable ABM. Multiple seizures and deep coma were less predictive (LR = 1.5–2.1). Single seizures and malaria parasitemia had low LRs (≤ 0.5). In logistic regression including clinical variables, Kernig’s sign and deep coma were positively associated with ABM, and a single seizure was negatively associated ( ≤ 0.01). In models including microscopy, neck stiffness and deep coma were positively associated with ABM and parasitemia was negatively associated with ABM ( ≤ 0.04). In young children, a bulging fontanel added to the model ( 0.001). Simple clinical features predict ABM in children in Papua New Guinea but malaria microscopy augments diagnostic precision.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Murray C, Lopez A, , 1996. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Global Burden of Disease and Injury Series, Volume 1. Boston, MA:  Harvard School of Public Health on behalf of the World Health Organization and The World Bank. [Google Scholar]
  2. Baraff LJ, Lee SI, Schriger DL, , 1993. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 12: 389394.[Crossref] [Google Scholar]
  3. Peltola H, , 2001. Burden of meningitis and other severe bacterial infections of children in Africa: implications for prevention. Clin Infect Dis 32: 6475.[Crossref] [Google Scholar]
  4. Wandi F, Kiagi G, Duke T, , 2005. Long-term outcome for children with bacterial meningitis in rural Papua New Guinea. J Trop Pediatr 51: 5153.[Crossref] [Google Scholar]
  5. Bijlmer H, van Alphen L, Greenwood B, Brown J, Schneider G, Hughes A, Menon A, Zanen H, Valkenburg H, , 1990. The epidemiology of Haemophilus influenzae meningitis in children under five years of age in The Gambia, West Africa. J Infect Dis 161: 12101215.[Crossref] [Google Scholar]
  6. Ward JI, Lum MK, Hall DB, Silimperi DR, Bender TR, , 1986. Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial. J Infect Dis 153: 1726.[Crossref] [Google Scholar]
  7. Davidson M, Parkinson AJ, Bulkow LR, Fitzgerald MA, Peters HV, Parks DJ, , 1994. The epidemiology of invasive pneumococcal disease in Alaska, 1986–1990: ethnic differences and opportunities for prevention. J Infect Dis 170: 368376.[Crossref] [Google Scholar]
  8. Lehmann D, Yeka W, Rongap T, Javati A, Saleu G, Clegg A, Michael A, Lupiwa T, Omena M, Alpers MP, , 1999. Aetiology and clinical signs of bacterial meningitis in children admitted to Goroka Base Hospital, Papua New Guinea, 1989–1992. Ann Trop Paediatr 19: 2132.[Crossref] [Google Scholar]
  9. Weber MW, Herman J, Jaffar S, Usen S, Oparaugo A, Omosigho C, Adegbola RA, Greenwood BM, Mulholland EK, , 2002. Clinical predictors of bacterial meningitis in infants and young children in The Gambia. Trop Med Int Health 7: 722731.[Crossref] [Google Scholar]
  10. Tulloch J, , 1999. Integrated approach to child health in developing countries. Lancet 354: (Suppl 2): SII16SII20.[Crossref] [Google Scholar]
  11. World Health Organization, 2000. Severe falciparum malaria. Trans R Soc Trop Med Hyg 94: (Suppl 1): S1S90. [Google Scholar]
  12. Berkley JA, Mwangi I, Mellington F, Mwarumba S, Marsh K, , 1999. Cerebral malaria versus bacterial meningitis in children with impaired consciousness. QJM 92: 151157.[Crossref] [Google Scholar]
  13. Shann F, Biddulph J, Vince J, , 2003. Paediatrics for Doctors in Papua New Guinea. Port Moresby, Papua New Guinea: Papua New Guinea Department of Health. [Google Scholar]
  14. Paediatrics Society of PNG, 2005. Standard Treatment for Common Illnesses of Children in PNG. 8th edition. Port Moresby, Papua New Guinea: Paediatrics Society of PNG. [Google Scholar]
  15. Berkley J, Anne C, Mwangi I, Lowe B, Newton C, , 2004. Indicators of acute bacterial meningitis in children at a rural Kenyan district hospital. Pediatrics 114: 713719.[Crossref] [Google Scholar]
  16. Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T, , 2010. Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics 126: 952960.[Crossref] [Google Scholar]
  17. Government of Papua New Guinea, 2002. Papua New Guinea 2000 Census. Port Moresby, Papua New Guinea: Government of Papua New Guinea. [Google Scholar]
  18. Muller I, Bockarie M, Alpers M, Smith T, , 2003. The epidemiology of malaria in Papua New Guinea. Trends Parasitol 19: 253259.[Crossref] [Google Scholar]
  19. Cattani JA, Tulloch J, Vrbova H, Jolley D, Gibson FD, Mois JS, Heywood PF, Alpers MP, Stevenson A, Clancy R, , 1986. The epidemiology of malaria in a population surrounding Madang, Papua New Guinea. Am J Trop Med Hyg 35: 315. [Google Scholar]
  20. Laman M, Manning L, Hwaiwhange I, Vince J, Aipit S, Mare T, Warrel J, Karunajeewa H, Siba P, Mueller I, Davis TM, , 2010. Lumbar puncture in children from an area of malaria endemicity who present with a febrile seizure. Clin Infect Dis 51: 534540.[Crossref] [Google Scholar]
  21. Molyneux ME, Taylor TE, Wirima JJ, Borgstein A, , 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q J Med 71: 441459. [Google Scholar]
  22. Karunajeewa HA, Mueller I, Senn M, Lin E, Law I, Gomorrai PS, Oa O, Griffin S, Kotab K, Suano P, Tarongka N, Ura A, Lautu D, Page-Sharp M, Wong R, Salman S, Siba P, Ilett KF, Davis TM, , 2008. A trial of combination antimalarial therapies in children from Papua New Guinea. N Engl J Med 359: 25452557.[Crossref] [Google Scholar]
  23. Duke T, Michael A, Mokela D, Wal T, Reeder J, , 2003. Chloramphenicol or ceftriaxone, or both, as treatment for meningitis in developing countries? Arch Dis Child 88: 536539.[Crossref] [Google Scholar]
  24. Negrini B, Kelleher KJ, Wald ER, , 2000. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics 105: 316319.[Crossref] [Google Scholar]
  25. Berkley J, Mwarumba S, Bramham K, Lowe B, Marsh K, , 1999. Bacteraemia complicating severe malaria in children. Trans R Soc Trop Med Hyg 93: 283286.[Crossref] [Google Scholar]
  26. Enwere G, Van Hensbroek MB, Adegbola R, Palmer A, Onyiora E, Weber M, Greenwood B, , 1998. Bacteraemia in cerebral malaria. Ann Trop Paediatr 18: 275278.[Crossref] [Google Scholar]
  27. Akpede GO, , 1995. Presentation and outcome of sporadic acute bacterial meningitis in children in the African meningitis belt: recent experience from northern Nigeria highlighting emergent factors in outcome. West Afr J Med 14: 217226. [Google Scholar]
  28. Shann F, Barker J, Poore P, , 1985. Chloramphenicol alone versus chloramphenicol plus penicillin for bacterial meningitis in children. Lancet 2: 681684.[Crossref] [Google Scholar]
  29. Tefuarani N, Vince J, , 1992. Purulent meningitis in children: outcome using a standard management regimen with chloramphenicol. Ann Trop Paediatr 12: 375383.[Crossref] [Google Scholar]
  30. McGee S, , 2002. Simplifying likelihood ratios. J Gen Intern Med 17: 646649.[Crossref] [Google Scholar]
  31. Molyneux E, Walsh A, Phiri A, Molyneux M, , 1998. Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996–7. Trop Med Int Health 3: 610618.[Crossref] [Google Scholar]
  32. Thomas KE, Hasbun R, Jekel J, Quagliarello VJ, , 2002. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 35: 4652.[Crossref] [Google Scholar]
  33. Waghdhare S, Kalantri A, Joshi R, Kalantri S, , 2010. Accuracy of physical signs for detecting meningitis: a hospital-based diagnostic accuracy study. Clin Neurol Neurosurg 112: 752757.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 15 May 2011
  • Accepted : 05 Sep 2011
  • Published online : 01 Feb 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error