Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Nov 1:11:301.
doi: 10.1186/1471-2334-11-301.

Clinical indicators of bacterial meningitis among neonates and young infants in rural Kenya

Michael K Mwaniki  1 , Alison W Talbert, Patricia Njuguna, Mike English, Eugene Were, Brett S Lowe, Charles R Newton, James A Berkley
Affiliations

Clinical indicators of bacterial meningitis among neonates and young infants in rural Kenya

Michael K Mwaniki et al. BMC Infect Dis. .

Abstract

Background: Meningitis is notoriously difficult to diagnose in infancy because its clinical features are non-specific. World Health Organization (WHO) guidelines suggest several indicative signs, based on limited data. We aimed to identify indicators of bacterial meningitis in young infants in Kenya, and compared their performance to the WHO guidelines. We also examined the feasibility of developing a scoring system for meningitis.

Methods: We studied all admissions aged < 60 days to Kilifi District Hospital, 2001 through 2005. We evaluated clinical indicators against microbiological findings using likelihood ratios. We prospectively validated our findings 2006 through 2007.

Results: We studied 2,411 and 1,512 young infants during the derivation and validation periods respectively. During derivation, 31/1,031 (3.0%) neonates aged < 7 days and 67/1,380 (4.8%) young infants aged 7-59 days (p < 0.001) had meningitis. 90% of cases could be diagnosed macroscopically (turbidity) or by microscopic leukocyte counting. Independent indicators of meningitis were: fever, convulsions, irritability, bulging fontanel and temperature ≥ 39°C. Areas under the receiver operating characteristic curve in the validation period were 0.62 [95%CI: 0.49-0.75] age < 7 days and 0.76 [95%CI: 0.68-0.85] thereafter (P = 0.07), and using the WHO signs, 0.50 [95%CI 0.35-0.65] age < 7 days and 0.82 [95%CI: 0.75-0.89] thereafter (P = 0.0001). The number needed to LP to identify one case was 21 [95%CI: 15-35] for our signs, and 28 [95%CI: 18-61] for WHO signs. With a scoring system, a cut-off of ≥ 1 sign offered the best compromise on sensitivity and specificity.

Conclusion: Simple clinical signs at admission identify two thirds of meningitis cases in neonates and young infants. Lumbar puncture is essential to diagnosis and avoidance of unnecessary treatment, and is worthwhile without CSF biochemistry or bacterial culture. The signs of Meningitis suggested by the WHO perform poorly in the first week of life. A scoring system for meningitis in this age group is not helpful.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Receiver operating characteristic curve of CSF total leukocyte count as a predictor of microbiologically confirmed meningitis in Kenyan neonates and young infants. A = 10 leukocytes per μl, B = 50 leukocytes per μl, C = 100 leukocytes per μl, D = 500 leukocytes per μl.
Figure 2
Figure 2
Flow chart of study participants.
See this image and copyright information in PMC

References

    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365(9462):891–900. doi: 10.1016/S0140-6736(05)71048-5. - DOI - PubMed
    1. Stoll BJ. The global impact of neonatal infection. Clin Perinatol. 1997;24(1):1–21. - PubMed
    1. World Health Organization. Pocket Book of Hospital Care for Children - Guidelines for the Management of Common Illnesses with Limited Resources. 2005. http://whqlibdoc.who.int/publications/2005/9241546700.pdf [cited 2009 March 12] - PubMed
    1. Hoque MM, Ahmed AS, Chowdhury MA, Darmstadt GL, Saha SK. Septicemic neonates without lumbar puncture: what are we missing? J Trop Pediatr. 2006;52(1):63–5. doi: 10.1093/tropej/fmi043. - DOI - PubMed
    1. Letson GW, Gellin BG, Bulkow LR, Parks DJ, Ward JI. Severity and frequency of sequelae of bacterial meningitis in Alaska Native infants. Correlation with a scoring system for severity of sequelae. Am J Dis Child. 1992;146(5):560–6. - PubMed

Publication types