[Pneumococcal meningitis in children. Review of 28 cases].

OBJECTIVE

To describe the epidemiological characteristics, clinical features and prognostic indicators of pneumococcal meningitis in children admitted to a children's hospital in Madrid.

PATIENTS AND METHODS

We retrospectively studied 28 children with a diagnosis of pneumococcal meningitis based on identification of S. pneumoniae in the blood or cerebrospinal fluid between 1990 and 1999. None of the children had previous immunological deficit or had received antipneumococcal vaccine.

RESULTS

The mean age of patients was 2.7 +/- 2.9 years (range 2 months to 11 years). Eighty-two percent of the children were younger than 5 years old. Male to female ratio was 1:1. The most frequent signs on admission were fever (100%), vomiting (57%), headache and irritability (53%), and shock (10%). Neurologic findings were lowered level of consciousness in 22 patients (man Glasgow Coma Scale score 9.9 +/- 3.9): seizures in 15 (53%); neck stiffness in 12 patients (42%) and arreactive mydriasis in 9 patients (32%). Twenty patients (71%) required admission to the intensive care unit. On discharge 15 patients (53%) had no sequelae; 8 patients (28%) suffered deafness; 4 (14%) had hemiparesis; 2 (7%) had severe hydrocephalus and 1 patient (3.5%) had mental retardation. Four patients (14%) died. Findings with the strongest predictive value for death or deafness (p > 0.05) were coma and alterations in cranial computer tomography (CT). Seizures, alterations in electroencephalogram (EEG) and hypoglycorrhachia were also prognostic indicators for deafness (p < 0.05).

CONCLUSIONS

Meningitis caused by S. pneumoniae is a significant cause of morbidity and mortality in children. Deafness is one of the most common and serious sequelae of pneumococcal meningitis. Sequelae were associated with coma, alterations in CT scan, seizures and hypoglycorrhachia. The new, antipneumococcal conjugated vaccine will confer effective prevention from the age of 2 months and will produce a dramatic decrease in the incidence of this serious infection.