Vaccination Status and Clinical Spectrum of Children with Pyogenic Meningitis in A Tertiary Care Hospital of Hazara Division, Pakistan

Background: Pyogenic meningitis is one of the serious causes of mortality and morbidity in children. It is more prevalent in third world countries with poor vaccination coverage. This study was done to determine the vaccination status and clinical spectrum of pyogenic meningitis in children presenting to a tertiary care hospital. Methods: This cross-sectional study was carried out from August, 2017 till January, 2020 over 2.5 years. Records of children who got admitted in pediatric B ward, of either gender between ages of 1 month to 14 years diagnosed as case of pyogenic meningitis were included. Records of vaccination status along with signs of meningeal irritation, complications and outcome during hospital stay were documented. Data was analyzed by SPSS 20 and chi square test applied. P value < 0.05 was taken as significant. Results: There were 117 patients, 78 males and 39 females. Age ranged from 1 month to 14 years with mean age of 5.51± 4.19 years. Patients who were vaccinated up to date were 49.6% and 37.6% were not vaccinated at all. Main presenting feature was fever and seizures especially under one year of age. There was significant association between seizures and age group with p value of 0.001. Signs of meningeal irritation (neck stiffness, brudzinski sign, kerning sign) and paradoxical irritability were present in 85 (72.6%) patients mostly above 1 year of age. There was significant association between signs of meningeal irritation and age group (5 years and above) with p value of <0.001. 110 (94%) got discharged and one (0.9%) patient was referred while 6 (5.1%) patients expired. There was significant association between stay duration and vaccination status. (p = 0.018) Conclusion: Fever was the most common presentation and vaccinated children with pyogenic meningitis had shorter stay in hospital.

“Study of Estimation of Cerebrospinal Fluid C-Reactive Protein in Diagnosis of Acute Meningitis.”

Objectives:To assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitisand to evaluate the efficacy of CSF C-reactive protein in differentiating pyogenic meningitis fromnon-pyogenic meningitis.Material and Methods: It is a prospective observational study of total 102children with suspected meningitis allocated into three groups based on initial investigations; group-I Pyogenic meningitis, group-II Non-Pyogenic meningitis and group-III No meningitis (Controlgroup). Quantitative CSF C-reactive protein was detected by the latex agglutination method. Datawere analyzed to establish the diagnostic role of CSF-CRP and to evaluate the efficacy of CSF-CRP indifferentiating pyogenic meningitis from non-pyogenic meningitis.Results: A total of 102 clinicallysuspected meningitis patients were studied. Based on CSF findings, the study population (102cases) was categorized into 3 groups. Group I was pyogenic meningitis consist 53 cases (51.96%).Group II was Non-Pyogenic meningitis consists 27 cases (26.47%). Group III was normal CSFfindings consist 22 (21.56%). 98.1% cases of pyogenic meningitis had elevated CSF-CRP level >1.1μg/ml of CSF. In the case of Non-Pyogenic meningitis, 96.2% were found to have CSF- CRP in therange of 0.05-0.10 μg/ml. The mean value of CSF-CRP in groups I,II and III were 5.57±1.48,0.09±0.042 and 0.01±0.010 respectively. Conclusion: Detection of CSF-CRP provides a newdimension to establish the diagnosis of pyogenic meningitis. It is a rapid, reliable and sensitivediagnostic test. From this study it is concluded that CSF-CRP can be used to differentiate pyogenicfrom non-pyogenic meningitis. Early, accurate and appropriate therapy can ameliorate the morbidityand mortality rates in such cases.

Frequency of Sensorineural Hearing Loss among Children with Pyogenic Meningitis

Aim: To find out the frequency of sensorineural hearing loss among children with pyogenic meningitis. Study Design: Cross-sectional. Place and Duration of Study: Study was conducted at Ziauddin university hospital during the period of July 2019 to February 2020. Methodology: About 96 participants were enrolled in the study between the age group of one month up to 12 years. Patients were included on the basis of clinical presentation and laboratory findings of pyogenic meningitis. An expert audiologist performed the brainstem evoked response audiometry test before discharging the patient from the hospital. For data analysis SPSS version-20 was used. All the quantitative variables were calculated as mean with standard deviation while qualitative data were presented as frequency and percentages. To find out association between variables, the Mann Whitney U-test and chi-square test was applied while P-value ≤0.05 was considered as significant. Results: Mean age with standard deviation was 6.8 ±2.3. Majority of the study participants were boys (57%). The frequency of sensorineural hearing loss was 17%. It was more among females than their male counter parts that was 64.7% and 35.3% respectively but no significant association was reported. The younger age group was having higher frequency of sensorineural hearing loss (47.1%), followed by the age group of 6-8 years (29.4%) and the very small number of participants were affected from the age group of 9-12 years (23.5%) but all the age groups were having no significant association with frequency of hearing loss. Conclusion: It can be concluded that sensorineural hearing loss is the most common complication reported among the children with pyogenic meningitis in current setup so there is a need of early evaluation of hearing problems in all patients diagnosed with pyogenic meningitis.

Cerebrospinal Fluid and Serum C-Reactive Protein among Children with Acute Encephalitis Syndrome

Objectives This study aimed to evaluate the positivity of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum in children presented with clinical diagnosis of acute encephalitis syndrome (AES). Methods A total of 164 children between 6 months and 14 years with clinical diagnosis of AES were investigated. Qualitative CRP (slide agglutination) was determined in CSF and serum sample of each patient. On the basis of clinical examination and investigations, all the patients were divided into four groups as pyogenic meningitis, viral encephalitis, tuberculous meningitis, and cerebral malaria. The positivity of CRP in CSF and serum were compared in these groups. Results CSF CRP was found to be positive in the majority of patients with pyogenic meningitis and a statistically significant (p ≤ 0.001) association was found between CSF CRP and final diagnosis of AES, while this association was nonsignificant (p = 0.141) in case of serum CRP. When we compared the CSF and serum CRP, serum CRP was found to be more suggestive of tuberculous meningitis, viral encephalitis, and cerebral malaria while CSF CRP was more sensitive and specific for the diagnosis of pyogenic meningitis. Conclusion The sensitivity and specificity of CSF CRP for pyogenic meningitis was quite high. Serum CRP with a high sensitivity can be used as a screening test for different types of meningitis and cerebral malaria; however, its diagnostic accuracy has yet to be established.

Rapid differential diagnostic methods of meningitis in adults

Background: Acute infections of the nervous system are among the most importantproblems in medicine because early recognition, efficient decision making, and rapid institution of therapy can be lifesaving. Objective of the present study was to find out the usefulness of these two tests, CSF-ADA and CSF-CRP for the rapid diagnosis and differentiation of bacterial, tubercular and viral meningitis in adults.Methods: Fifty meningitis patients were selected after fulfilling the following inclusion and exclusion criteria. A prospective clinical evaluation study is undertaken to study the predictive value of CSF CRP and ADA in relation to various types of meningitis.Results: More than half the cases reported were of tubercular meningitis, followed by viral and pyogenic meningitis. The percentages of tubercular, viral and pyogenic were 52%, 32% and 16% respectively. CRP levels were elevated in pyogenic meningitis; the mean CRP level was 25.26±5.56 mg/dl. ADA activity was found to highest in tubercular meningitis, the mean value was 17.67±8.13 IU/L.Conclusions: Study concluded that combine use of CSF CRP and ADA can be used for early differentiation of bacterial, tubercular, and viral meningitis.

Evaluation of Lactate in Differentiating Pyogenic and Non-Pyogenic Meningitis

Background : Meningitis is serious and a life-threatening condition among any age group associated with serious mortality and morbidity. The objective of the present research was to assess the efficiency of CSF lactate in differentiating bacterial/ pyogenic from non-pyogenic meningitis. Subjects and Methods: A hospital-based one-year prospective study was conducted at a tertiary care hospital in Gujarat. The study was performed at the department of General medicine for a period of one year. All the cases suspected of meningitis above 18 years of age irrespective of sex were admitted and clinically evaluated. The Diagnosis of meningitis was made on account of various clinical symptoms and signs. Like headache, nausea, presence of kernig’s sign, altered sensorium, cranial nerves palsies, hemiparesis, seizures, etc, Results: The mean total cell count was highest in cases of pyogenic meningitis with a mean of 840.50 and SD of 112.30 than viral and tubercular meningitis. However, no statistical significance was associated with total count and types of meningitis. (P> 0.05) Lactate levels of the CSF were elevated than normal in both pyogenic and tubercular than viral, however, the mean CSF lactate was higher in pyogenic than tubercular. A clear statistical significance was observed in CSF sugar/blood glucose ratio and CSF lactate levels in this study (p 0.05). Conclusion: CSF lactate level is a rapid, quite inexpensive and unpretentious process, important diagnostic indicator in the premature demarcation of pyogenic meningitis and tubercular meningitis from viral meningitis, serving in the premature organization of proper action and diminishing transience and impediments. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.

Estimation of cerebrospinal fluid lactate level to differentiate between pyogenic and non-pyogenic meningitis: a prospective analytical study

Background: Meningitis is one of the common causes of serious morbidity and mortality and is one of the common causes of intensive care unit (ICU) admissions. The meningitis can be broadly divided into bacterial, viral or fungal meningitis. It is important to differentiate between pyogenic and non-pyogenic meningitis because of obvious management implications. Cerebrospinal fluid (CSF) lactate levels can be used for differentiating pyogenic and non-pyogenic (viral/tubercular) meningitis.Methods: This was a prospective analytical study in which cases diagnosed to be having meningitis were included on the basis of a predefined inclusion and exclusion criteria. Demographic details such as age, gender and socioeconomic status was note in all the cases. A detailed clinical history was taken and a through clinical examination was done. Imaging (computerized tomography) was done in selected cases. CSF cytology, biochemistry and culture sensitivity were done in all cases. CSF lactate was determined in all cases.Results: The CSF cytological examination showed that the mean total cell count was more (643.23±102.02) in pyogenic meningitis as compared to non-pyogenic (viral/tubercular) meningitis (121.76±59.74) and the difference was found to be statistically highly significant (p<0.0001). The analysis of CSF lactate levels showed that pyogenic meningitis cases had a significantly high level of CSF lactate as compared to non-pyogenic meningitis cases and the difference was found to be statistically highly significant (p<0.0001).Conclusions: CSF lactate level is a good indicator in differentiating pyogenic and non-pyogenic meningitis.