Predictors of Acute Bacterial Meningitis in Children from a Malaria-Endemic Area of Papua New Guinea

Moses Laman Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Laurens Manning Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Andrew R. Greenhill Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Trevor Mare Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Audrey Michael Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Silas Shem Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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John Vince Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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William Lagani Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Ilomo Hwaiwhanje Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Peter M. Siba Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Ivo Mueller Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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Timothy M. E. Davis Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea; School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia; Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain; Family Health Services, National Department of Health, Port Moresby, Papua New Guinea

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DOI:
https://doi.org/10.4269/ajtmh.2012.11-0312
Volume/Issue:
Volume 86: Issue 2
Page(s):
240–245
Restricted access
Get Permissions

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 (P ≤ 0.01). In models including microscopy, neck stiffness and deep coma were positively associated with ABM and parasitemia was negatively associated with ABM (P ≤ 0.04). In young children, a bulging fontanel added to the model (P < 0.001). Simple clinical features predict ABM in children in Papua New Guinea but malaria microscopy augments diagnostic precision.

Author Notes

*Address correspondence to Timothy M. E. Davis, University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia. E-mail: tdavis@cyllene.uwa.edu.au

Financial support: This study was supported by the National Health and Medical Research Council (NHMRC) of Australia (grant no. 513782). Moses Laman was supported by a Fogarty Foundation scholarship, Laurens Manning was supported by Royal Australasian College of Physicians (Basser) and NHMRC scholarships, and Timothy M. E. Davis was supported by an NHMRC Practitioner Fellowship.

Authors’ addresses: Moses Laman, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea, and University of Western Australia and School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia, E-mail: drlaman@yahoo.com. Laurens Manning and Timothy M. E. Davis, University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia, E-mails: larmens@xtra.co.nz and tdavis@cyllene.uwa.edu.au. Andrew R Greenhill, Audrey Michael, and Peter M. Siba, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea, E-mails: andrew.greenhill@yahoo.com.au, audrey.michael@pngimr.org.pg, and peter.siba@pngimr.org.pg. Trevor Mare and Silas Shem, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea, E-mails: trevor.mare@pngimr.org.pg and silas.shem@pngimr.org.pg. John Vince, Department of Pediatrics, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea, E-mail: johndvince@gmail.com. William Lagani, Family Health Services, National Department of Health, Port Moresby, Papua New Guinea, E-mail: william.lagani@pngimr.org.pg. Ilomo Hwaiwhanje, Department of Pediatrics, Goroka Base Hospital, Goroka, Eastern Highlands Province, Papua New Guinea, E-mail: wohuiereke@hotmail.com. Ivo Mueller, Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain and Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia, E-mail: ivomueller@fastmail.fm.

Reprint requests: Timothy M. E. Davis, University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia, E-mail: tdavis@cyllene.uwa.edu.au

Copyright:
©The American Society of Tropical Medicine and Hygiene 2012
Received:
15 May 2011
|
Accepted:
05 Sep 2011
|
Published Online:
01 Feb 2012
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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