Molyneux Elizabeth, Riordan F Andrew I, Walsh Amanda
Department of Paediatrics, College of Medicine, Blantyre, Malawi.
Ann Trop Paediatr. 2006 Mar;26(1):29-37. doi: 10.1179/146532806X90583.
Bacterial meningitis is a serious childhood illness worldwide. Children can now be immunised against meningitis with conjugate vaccines. The outcome of bacterial meningitis in British and Malawian children before the introduction of these vaccines was compared.
All children with culture-positive bacterial meningitis treated in the Royal Liverpool Children's Hospital (RLCH), UK during 1984-1991 (n=197) and in the Children's Unit, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi during 1996-1997 (n=175) were studied.
Children at QECH presented later and were more often comatose and malnourished. Mortality was 7% in RLCH compared with 41% in QECH. Three organisms caused most cases of meningitis: N. meningitidis 56% vs 4%, H. influenzae b 27% vs 25%, and S. pneumoniae 11% vs 35% in RLCH and QECH, respectively. Mortality was lower in RLCH for each organism: N. meningitidis 10% vs 28%, H. influenzae b 6% vs 43%, S. pneumoniae 0% vs 46%.
Mortality from bacterial meningitis in Malawian children is much higher than in British children, even when infected with the same organisms. This might be owing to delay in presentation, malnutrition and HIV infection. Immunisation of Malawian children with conjugate vaccines should continue to develop since their risk of dying from meningitis is five times greater than that of British children.
细菌性脑膜炎是一种在全球范围内严重的儿童疾病。现在儿童可以通过接种结合疫苗来预防脑膜炎。对引入这些疫苗之前英国和马拉维儿童细菌性脑膜炎的结局进行了比较。
对1984年至1991年期间在英国皇家利物浦儿童医院（RLCH）接受治疗的所有培养阳性细菌性脑膜炎儿童（n = 197）以及1996年至1997年期间在马拉维布兰太尔伊丽莎白女王中央医院儿童病房（QECH）接受治疗的儿童（n = 175）进行了研究。
QECH的儿童就诊时间较晚，且更常出现昏迷和营养不良。RLCH的死亡率为7%，而QECH为41%。三种病原体导致了大多数脑膜炎病例：脑膜炎奈瑟菌在RLCH和QECH中分别为56%对4%，b型流感嗜血杆菌为27%对25%，肺炎链球菌为11%对35%。每种病原体在RLCH的死亡率都较低：脑膜炎奈瑟菌为10%对28%，b型流感嗜血杆菌为6%对43%，肺炎链球菌为0%对46%。
即使感染相同的病原体，马拉维儿童细菌性脑膜炎的死亡率也远高于英国儿童。这可能是由于就诊延迟、营养不良和艾滋病毒感染。由于马拉维儿童死于脑膜炎的风险是英国儿童的五倍，因此应继续推进为马拉维儿童接种结合疫苗的工作。
