Initiation of early empiric treatment based on clinical features and early obtainable CSF indices can prevent worse prognosis in childhood meningitis

Abstract

Childhood meningitis is still a major cause of neurological disabilities and death, which can be reduced by early initiation of treatment. This study was done with an objective to diagnose childhood meningitis earlier based on clinical characteristics and early obtainable cerebrospinal fluid (CSF) indices, which help to start early empiric treatment and prevent worse prognosis. The study was conducted during the period of January to December; 2003. One hundred suspected cases of childhood meningitis aged 1 month to 12 years admitted into the Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh were selected for the study. It was a prospective study and sampling was purposive. Diagnosis was made by history, clinical examination, complete blood count and CSF study. Early treatment was started. Number of deaths was noted and neurological outcome was assessed in children who survived by clinical examination at the time of discharge. Study results showed 64% bacterial, 20% tuberculous and 6% viral meningitis. Fever (100%), altered consciousness (100%) were the most common features in all type of meningitis. Other predominant features were convulsion (90%), bulged fontanel (68%), reluctant to feed (67.18%), neck rigidity (67%) and vomiting(43.75%) in bacterial meningitis, convulsion (75%), neck rigidity (65%), vomiting (40%) and focal neurological signs (35%) in tuberculous meningitis, reluctant to feed (100%), convulsion (83.3%), neck rigidity (83.3%) and vomiting (66.6%) in viral meningitis. In all cases of meningitis CSF total leukocyte count was >5/mm3. Regarding immediate outcome in bacterial meningitis 48.8% improved without neurological sequelae, 43.7% patient developed neurological sequelae and 4.6% patient died. In tuberculous group, only 30% improved without neurological sequelae, 40% developed neurological sequelae and 20% patient died. In viral meningitis 83.3% improved without neurological sequelae. Duration of the main complaint specially fever at the time of presentation, level of consciousness, convulsion were the most important predictor of out come in childhood meningitis.