Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability

Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease.

Laboratory finding of CSF analysis in patients with meningitis at Elamin Hamid Pediatrics Hospital in Khartoum, Sudan

Bacterial meningitis in infants and children is a serious clinical entity with signs and symptoms that commonly do not allow distinguishing the diagnosis and the causative agents. The only method to determine if meningitis is the cause of these symptoms is a lumbar puncture. Lumbar puncture is the gold standard for the diagnosis and should be done in all suspected cases of meningitis unless contraindicated. Objectives: The purpose of this study is to identify the importance of the microbiological study of cerebrospinal fluid (CSF) in patients suspected to have acute meningitis. Despite the availability of all other investigations and Imaging for diagnosis of meningitis but CSF analysis remains the most available, accurate, and cheaper for diagnosis of meningitis in children. Methodology and result: This is a prospective study. 71 patients were included. All patients were clinically suspected to have acute meningitis. A lumbar puncture for CSF analysis was done for all patients. The data was collected and analysed. CSF culture was done. The culture was negative In 58 patients (81.7%) and positive in 13 patients (18.3%). Streptococcus was found in 3 patients (4.2 %), staphylococcus epidermidis in 2 patients (2.8%), E Coli in 2 patients (2.8%), klebsiella in 2 patients (2.8%), pneumococci in 2 patient (2.8%), salmonella in 1 patient (1,4%) and Bacilli in 1 patient (1.4 %). Recommendation: Lumbar Puncture (LP) remains the easiest, cheapest and accurate investigation for diagnosis of meningitis in children mainly in rural areas in Sudan and other developing countries. It’s mandatory to offer training for doctors and medical staff for doing lumber punctures safely and accurately and to offer well-equipped laboratories for such essential investigations. It’s not only the role of doctors and medical staff but is a governmental obligation as well. This can save a lot of sick children and prevent mortality and morbidity of acute meningitis in children.

The rationality behind performance of routine lumber puncture in simple febrile seizure in 6-18 months old children

Background: Pediatrics seizures can be either due to febrile seizure or underlying serious infection such as meningitis. It is important to rule out meningitis in children presenting with fever and seizure. The aim of the study was conducted to assess the necessity of routine lumber puncture and to determine the incidence of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure.Methods: This prospective observational study was conducted among 47 children with first episode of simple febrile seizure presenting to emergency in Medical College Kolkata, West Bengal from April 2018 to September 2019.Results: Total 47 children were studied among 32 (68%) children were between 6-12 months and 15 (32%) were between 12-18 months of age. Only 1 child (2.1%) diagnosed as meningitis. Clinically 7 children (14.9%) showed signs of sepsis and meningitis like picture and 6 children (12.8%) were in 6-12 months of age and only 1 child (2.1%) was in 12-18month of age. Only 1 child in 6-12 months of age showed CSF positive and all other CSF studies were within normal limit. A significant association was seen between age group and hyponatremia and family history of febrile seizure (p<0.05). There was no statically significant between clinical diagnosis and CSF results (p=0.15).Conclusions: The risk of meningitis in children presenting with simple febrile seizure between 6-18 months of age is very low, specially in 12-18 months of age. Therefore, current guidelines regarding lumber puncture in simple febrile seizure should be reconsidered.

Bacterial purulent meningitis in children: is there a light at the end of the tunnel?

Bacterial purulent meningitis is a life-threatening disease characterized by high mortality and severe consequences in survivors. Despite the modern possibilities of medicine, the disease continues to be a heavy burden on health care, the economy and society everywhere.Aim. To draw the attention of doctors to the problems associated with modern features of epidemiology, the consequences and possibilities of preventing bacterial purulent meningitis, especially in children, who constitute the main risk group for the development of this pathology.Literature review of Russian and foreign publications on the problem under consideration presented.Vaccination is recognized as one of the main tools for reducing morbidity and mortality from meningitis. Prophylactic vaccinations against N. meningitidis, Str.pneumoniae, H. influenzae, along with strict adherence to anti-epidemic measures in hospitals providing care to newborns, can help reduce the incidence of purulent meningitis in children and improve outcomes if they develop.

261. A Rare Case of Meningitis and Symptomatic Hydrocephalus by Listeria Monocytogenes in Dermatomyositis: A Case Report

Background Listeria monocytogenes is a gram-positive, facultative anaerobic bacillus common in the intestinal flora of many animals and humans. We describe an unusual case of meningitis by Listeria monocytogenes (LM) complicated by hydrocephalus in a child with dermatomyositis. Methods A 15-year-old girl presented to an outside hospital (OH) after a three-day history of headache, fever and was hospitalized with a diagnosis of meningitis and lumbar puncture performed. CSF sample could not be evaluated clearly due to its hemorrhagic nature. Her past medical history was significant for dermatomyositis for five years. She had received induction of IVIG five days prior. She was also taking cyclosporin A and hydroxychloroquine. She was empirically treated with intravenous cefotaxime, vancomycin, and acyclovir. She was urgently transferred to the theatre for an external shunt placement in the right lateral ventricle. The interval between the first symptoms and the diagnosis of hydrocephalus was around 4 days. CSF from this catheter showed growth of LM with sensitivity to meropenem and resistance to erythromycin, ampicillin, and sulfamethoxazole-trimethoprim. Gram staining of CSF resulted negative for bacteria. Cefotaxime was switched to intravenous meropenem. Immunological screening of cellular and humoral immunity, complement, and blood iron levels were normal. SARS-Cov2 PCR and HIV tests were negative. Herpes virus, mycobacterium tuberculosis real-time PCR, respiratory viral panel studied in the CSF sample were negative. MRI and Angio of the brain showed no abnormality. She is being followed in the pediatric intensive care unit as intubated. Results In patients who received immunosuppressive medication, L. monocytogenes should be evaluated in the differential diagnosis of central nervous system infections. Even if effective antibiotic therapy has been initiated, this case highlights the need of recognizing early hydrocephalus as a consequence of Listeria meningitis in children with neurological deterioration a few days after initial presentation. Conclusion The literature on the management and outcome of Listeria meningitis-related hydrocephalus in children is limited. Disclosures All Authors: No reported disclosures

Sentinel surveillance for bacterial pneumonia and meningitis in children under the age of 5 in a tertiary pediatric hospital in Colombia - 2016

Introduction: Bacterial pneumonia and meningitis are vaccine-preventable diseases. Sentinel surveillance provides relevant information about their behavior.Objective: To present the data from sentinel surveillance carried out at the Fundación HOMI, Fundación Hospital Pediátrico La Misericordia in 2016.Materials and methods: We conducted a descriptive study from January 1 to December 31, 2016, on the daily surveillance of patients under 5 years of age diagnosed with pneumonia or bacterial meningitis according to PAHO’s definitions. We identified the microorganisms using the automated VITEKTM 2 system. Bacterial isolates were sent to the Microbiology Group at the Colombian Instituto Nacional de Salud for confirmation, serotyping, phenotypic, and genotypic characterization. Antimicrobial susceptibility profiles were established.Results: From 1,343 suspected cases of bacterial pneumonia, 654 (48.7%) were probable, 84% had complete Hib vaccination schedules, and 87% had complete pneumococcal vaccination schedules for age. Blood culture was taken in 619 (94.6%) and 41 (6.6%) were positive while S. pneumoniae was isolated in 17 (41%) of them. The most frequent serotype was 19A in five cases (29.4%), and four 19A serotypes were associated with the reference isolate ST320. The incidence rate of probable bacterial pneumonia was 7.3 cases/100 hospitalized patients, and lethality was 2.1%. As for bacterial meningitis, 22 suspected cases were reported, 12 (54%) were probable, four (33%) were confirmed: two by Escherichia coli and two by group C N. meningitidis. The incidence of probable bacterial meningitis was 0.14 cases/100 hospitalized patients.Conclusion: Streptococcus pneumoniae serotypes 19A and 3 were the most frequent cause of pneumonia. Spn19A is related to the multi-resistant clone ST320. Strengthening and continuing this strategy will allow understanding the impact of vaccination.