Clinical data in children with meningococcal meningitis in a Spanish hospital
1997; Wiley; Volume: 86; Issue: 1 Linguagem: Inglês
10.1111/j.1651-2227.1997.tb08826.x
ISSN1651-2227
AutoresC. Luaces Cubells, Juan José García‐García, J Roca Martinez, C Latorre Otin,
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoNeisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19h, p = 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p = 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+= 25h, GS ‐ = 16h, p = 0.004; CSF+= 20h, CSF ‐ = 12h, p = 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC+= 14 h, BC = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) ( p = 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third‐generation cephalosporine.
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