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.

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