1921
Volume 86, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2012.11-0312
2012-02-01
2017-09-19
Loading full text...

Full text loading...

/deliver/fulltext/14761645/86/2/240.html?itemId=/content/journals/10.4269/ajtmh.2012.11-0312&mimeType=html&fmt=ahah

References

  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.
  2. Baraff LJ, Lee SI, Schriger DL, , 1993. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 12: 389394.[Crossref]
  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]
  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]
  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]
  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]
  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]
  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]
  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]
  10. Tulloch J, , 1999. Integrated approach to child health in developing countries. Lancet 354: (Suppl 2): SII16SII20.[Crossref]
  11. World Health Organization, 2000. Severe falciparum malaria. Trans R Soc Trop Med Hyg 94: (Suppl 1): S1S90.
  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]
  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.
  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.
  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]
  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]
  17. Government of Papua New Guinea, 2002. Papua New Guinea 2000 Census. Port Moresby, Papua New Guinea: Government of Papua New Guinea.
  18. Muller I, Bockarie M, Alpers M, Smith T, , 2003. The epidemiology of malaria in Papua New Guinea. Trends Parasitol 19: 253259.[Crossref]
  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.
  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]
  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.
  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]
  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]
  24. Negrini B, Kelleher KJ, Wald ER, , 2000. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics 105: 316319.[Crossref]
  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]
  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]
  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.
  28. Shann F, Barker J, Poore P, , 1985. Chloramphenicol alone versus chloramphenicol plus penicillin for bacterial meningitis in children. Lancet 2: 681684.[Crossref]
  29. Tefuarani N, Vince J, , 1992. Purulent meningitis in children: outcome using a standard management regimen with chloramphenicol. Ann Trop Paediatr 12: 375383.[Crossref]
  30. McGee S, , 2002. Simplifying likelihood ratios. J Gen Intern Med 17: 646649.[Crossref]
  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]
  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]
  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]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2012.11-0312
Loading
/content/journals/10.4269/ajtmh.2012.11-0312
Loading

Data & Media loading...

  • Received : 15 May 2011
  • Accepted : 05 Sep 2011

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