PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.
Anorexia ; Demography ; Escherichia coli ; Fever ; Glucose ; Haemophilus influenzae ; Hand ; Headache ; Hearing ; Hospitals, General ; Humans ; Influenza, Human ; Leukocyte Count ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Neisseria meningitidis ; Paresis ; Pneumonia ; Prognosis ; Retrospective Studies ; Seizures ; Streptococcus ; Streptococcus pneumoniae ; Subdural Effusion ; Vaccination ; Vomiting

OBJECTIVETo characterize the incidence, epidemiologic features, etiologic agents and sequelae of bacterial meningitis in children under 5 years of age in Nanning, Guangxi.

METHODSA population-based surveillance was conducted to evaluate children with signs and symptoms of meningitis. All hospitals, township health centers and village clinics in the surveillance area were structured to participate in the case referral and evaluation. Cerebrospinal fluid (CSF) and blood specimens were obtained and processed using standardized microbiologic methods.

RESULTSDuring the 26-month surveillance period, among the children under 5 years old, a total of 1272 cases who met the screening criteria of meningitis were studied. 265 of 1272 cases were identified as clinically diagnosed meningitis, with an incidence rate of 86.36 per 100 000 population. The annual incidence rate under the 38 cases of confirmed bacterial meningitis appeared to be 12.38/100 000. Staphylococcus species accounted for the largest proportion of laboratory-confirmed bacterial meningitis, followed by E. coli and S. pneumoniae. The highest attack rate occurred in neonates < 1 month, followed by children aged 1 - 12 months in the confirmed patients. Meningitis caused by Sp and Hi mainly occurred in children aged 1 - 12 months. All cases of meningitis due to Hi and Sp were children aged 1 - 24 months. 13.16% and 0.00% of the cases survived with complications and sequelae, and the case-fatality rate was 18.42%. 40 bacterial isolates were identified from 1193 blood cultures and 23 from 1211 cerebrospinal fluid samples, but no Neisseria meningitidis was found.

CONCLUSIONMeningitis due to Hi was first confirmed in Guangxi with the incidence of 0.98 per 100 000 population. The annual incidence rate of confirmed bacterial meningitis was 12.38 per 100 000, which was considered an important public health problem in children. Staphylococci was the predominant pathogen in confirmed bacterial meningitis.

Child, Preschool ; China ; epidemiology ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial ; epidemiology ; microbiology ; Meningitis, Escherichia coli ; epidemiology ; Meningitis, Haemophilus ; epidemiology ; Population Surveillance ; Staphylococcal Infections ; epidemiology

Advances in neonatal intensive care have improved the chances for survival of extremely low birth weight (ELBW) infants. However, ELBW infants are at high risk of meningitis and resulting neurologic complications. The most common organisms associated with neonatal bacterial meningitis include Listeria monocytogenes, Escherichia coli, and Group B Streptococcus. Bacillus cereus (B. cereus), an organism commonly found in soil, vegetation, and daily products, can sometimes cause meningitis owing to preformed toxins. We report a rare case of meningoencephalitis caused by B. cereus that resulted in a detrimental neurological outcome in an ELBW infant.
Bacillus cereus* ; Escherichia coli ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Listeria monocytogenes ; Meningitis ; Meningitis, Bacterial ; Meningoencephalitis* ; Soil ; Streptococcus

PURPOSE: Bacterial meningitis is a serious infection of childhood associated with a significant morbidity and mortality. Repeated cerebrospinal fluid(CSF) examination is a useful prognostic indicator and a delayed sterilization is associated with a higher incidence of neurologic abnormalities. In this study we tried to determine the prognostic value of repeated CSF latex agglutination testing. METHODS: We retrospectively evaluated 19 patients admitted to Ewha Womans University Mokdong Hospital for bacterial meningitis from January 1997 to June 2002. Bacterial meningitis was confirmed by a positive CSF culture and a positive CSF latex agglutination test. Repeated CSF examinations were done at three, seven, 14, 21 and 28 days after antibiotics therapy. Neuroradiologic studies were performed. RESULTS: The mean age was 10.6 +/- 12.3 months(range; two to 33 months). The male to female ratio was 2.8 : 1. The causative organisms were Haemophilus influenzae type b 57.9%, Group B Streptococcus 21.1%, Streptococcus pneumoniae 15.7% and Escherichia coli 5.3%. Three days after the initiation of antibiotics therapy, repeated CSF latex agglutination tests persisted as positive in nine (47.4%) out of 19 cases, but all CSF cultures became negative. In those cases with negative latex agglutination tests three days after antibiotics therapy, neuroradiologic findings were completely normal. But, in cases with positive latex agglutination tests three days after antibiotics therapy, neuroradiologic abnormalities such as cerebral infarction, encephalomalasia occurred in 44.4%. CONCLUSION: Repeated CSF latex agglutination testing was valuable as a prognostic factor in bacterial meningitis. Neuroradiologic abnormalities may occur in cases with delayed clearance of CSF latex agglutination tests more often than in cases with negative latex agglutination tests three days after antibiotics therapy.
Anti-Bacterial Agents ; Cerebral Infarction ; Escherichia coli ; Female ; Haemophilus influenzae type b ; Humans ; Incidence ; Latex Fixation Tests* ; Latex* ; Male ; Meningitis, Bacterial* ; Mortality ; Retrospective Studies ; Sterilization ; Streptococcus ; Streptococcus pneumoniae

PURPOSE: Despite the seriousness of bacterial meningitis in children, there is little information on the incidence, causative organisms, mortality rate and age distribution. We studied the frequency by age group and causal pathogens, and clinical characteristics in children with bacterial meningitis in the private sector in Korea. METHODS: The medical records containing the data on bacterial meningitis patients under 18 years of age confirmed by cerebrospinal fluid (CSF) findings were retrospectively analyzed from September, 1993 to August, 2006 at Ewha Womans University Mokdong Hospital. RESULTS: Eighty-one cases of bacterial meningitis were observed. Overall the most common organism was Streptococcus agalactiae (group B streptococcus, GBS) (30 cases, 37.0%) followed by Haemophilus influenzae (22 cases, 27.2%), Streptococcus pneumoniae (12 cases, 14.8%), Escherichia coli (3 cases, 3.7%), Neisseria meningitidis (1 case, 1.2%) and others (13 cases, 16.0%). In neonates and young infants under 2 months, the most common organism was GBS. In children between 3 months, and 5 years, the most common organism was H. influenzae. S. pneumoniae was the most common organism in children over 5 years of age. Thirty-one patients (38.3%) had complications. Of all ages, the mortality rate of bacterial meningitis markedly decreased compared with the previously reported rate. CONCLUSION: In neonates, GBS meningitis was most common. The frequency of H. influenzae meningitis decreased after the introduction of H. influenzae type b vaccination. A strategy for the prevention of GBS meningitis in neonates should be established. The influence of the pneumococcal conjugate vaccine on S. pneumoniae meningitis should be studied
Age Distribution ; Child ; Escherichia coli ; Female ; Haemophilus influenzae ; Humans ; Incidence ; Infant ; Infant, Newborn ; Influenza, Human ; Korea ; Medical Records ; Meningitis ; Meningitis, Bacterial ; Neisseria meningitidis ; Pneumonia ; Private Sector ; Retrospective Studies ; Streptococcus ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Vaccination

BACKGROUND: Invasive bacterial infections in apparently immunocompetent children were retrospectively analyzed to figure causative bacterial organisms in Korea. METHODS: A total of 947 cases from 25 university hospitals were identified from 2006 to 2010 as a continuance of a previous 10-year period study from 1996 to 2005. RESULTS: Escherichia coli (41.3%), Streptococcus agalactiae (27.7%), and Staphylococcus aureus (27.1%) were the most common pathogens in infants < 3 months of age. S. agalactiae was the most prevalent cause of meningitis and pneumonia and E. coli was the major cause of bacteremia without localizing signs in this group. In children 3 to 59 months of age, Streptococcus pneumoniae (54.2%), S. aureus (20.5%), and Salmonella spp. (14.4%) were the most common pathogens. S. pneumoniae was the leading cause of pneumonia (86.0%), meningitis (65.0%), and bacteremia without localizing signs (49.0%) in this group. In children ≥ 5 years of age, S. aureus (62.8%) was the predominant pathogen, followed by Salmonella species (12.4%) and S. pneumoniae (11.5%). Salmonella species (43.0%) was the most common cause of bacteremia without localizing signs in this group. The relative proportion of S. aureus increased significantly over the 15-year period (1996–2010) in children ≥ 3 months of age (P < 0.001), while that of Haemophilus influenzae decreased significantly in both < 3 months of age group (P = 0.036) and ≥ 3 months of age groups (P < 0.001). CONCLUSION: S. agalactiae, E. coli, S. pneumoniae, and S. aureus are common etiologic agents of invasive bacterial infections in Korean children.
Bacteremia ; Bacterial Infections ; Child ; Epidemiology ; Escherichia coli ; Haemophilus influenzae ; Hospitals, University ; Humans ; Infant ; Korea ; Meningitis ; Pneumonia ; Retrospective Studies ; Salmonella ; Staphylococcus aureus ; Streptococcus agalactiae ; Streptococcus pneumoniae

Movement disorders (chorea, athetosis, ballism) are a rare complication that develops during the course of bacterial meningitis although associations with tuberculous meningitis are established to some extent. Movement disorders are generally believed to reflect injury to the basal ganglia, thalamus, cerebellum and cerebral cortex. Ischemic infarctions of these areas have been proposed as the cause of dyskinesias in bacterial meningitis. We experienced a case of chorea which developed in the recovery phase of pnemococcal meningitis in a 37-month-old boy. The choreic movement was initially misinterpreted as a seizure, and anticonvulsants were administered. The movement continued during the alert state in spite of anticonvulsant therapy but subsided during sleep. EEG showed severely depressed background activitiy with no epileptiform discharge. When the movement was recognized as a choreic movement, anticonvulsants were withheld and haloperidol was administered orally. The abnormal movement gradually disappeared in 3 months. But like the two other previously reported cases of postmenigitic movement disorders, this patient shows severe impairment in cognitive and motor function in the 10 months of follow up. He can only recognize some close persons and can not control the trunk and extremities well. The movement disorder which develops in the recovery phase and lasts for a long period may be associated with poor neurologic prognosis.
Anticonvulsants ; Athetosis ; Basal Ganglia ; Cerebellum ; Cerebral Cortex ; Child, Preschool ; Chorea* ; Dyskinesias ; Electroencephalography ; Extremities ; Follow-Up Studies ; Haloperidol ; Humans ; Infarction ; Male ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Movement Disorders ; Prognosis ; Seizures ; Thalamus ; Tuberculosis, Meningeal

PURPOSE: This study was performed to investigate the change in the causative organisms of bacterial meningitis and the prevalence of bacterial meningitis caused by antibiotics resistant strains in a single Korean tertiary center. METHODS: We retrospectively analyzed medical records of patients who had been diagnosed with bacterial meningitis from March 1999 to March 2010 at the Asan Medical Center. The bacterial meningitis was defined as the correlated clinical symptoms and the isolation of organisms from the cerebrospinal fluid culture. RESULTS: During the 11-year study period, we found 81 cases of CSF-culture proven bacterial meningitis. Streptococcus agalactiae (group B streptococcus, GBS) were most common bacteria accounting for 23 (28.3%) cases, followed by Streptococcus pneumoniae with 22 (27.2%), and Haemophilus influenzae with 8 (9.9%). After introduction of the vaccination, only one case of H. influenzae meningitis was documented. Seventeen of 18 (94.4%) cases of GBS were sensitive to the penicillin, whereas 82.4% (14/17) of S. pneumoniae were resistant to penicillin. Among the 17 cases of S. pneumoniae, 11 cases (64.7%) were multi-drug resistant strains but all were susceptible to vancomycin. CONCLUSION: In spite of the introduction of the vaccination, S. pneumoniae was the most common cause of bacterial meningitis in children older than two months. For pneumococcal meningitis, careful selection of antibiotics and ongoing research about antibiotics susceptibility will be needed due to multi-drug resistance.
Accounting ; Anti-Bacterial Agents ; Bacteria ; Child ; Drug Resistance ; Drug Resistance, Multiple ; Haemophilus influenzae ; Humans ; Influenza, Human ; Medical Records ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal ; Penicillins ; Pneumonia ; Prevalence ; Retrospective Studies ; Streptococcus ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Vaccination

Among 73 patients with possible and definite tuberculous meningitis, 14 cases showed a sudden unexpected polymorphonuclear (PMN) CSF pleocytosis during treatment. Patients with superimposed bacterial meningitis were excluded. Eleven patients(15. 1%) matched inclusion criteria. The intervals between the onset of the treatment and the onset of the PMN CSF pleocytosis were 7-54 days(mean 17.2+ 14.4 days). The mean duration of PMN CSF pleocytosis was 14.2+12.4 days. A PMN CSF pleocytosis may develop occasionally weeks or months after the start of the treatment for tuberculous meningitis. Though the cause is uncertain, we suggest that probably its cause is superimposed acute meningeal inflanunation by the release of Mycobacterium from tuberculomas or.delayed Jarisch-Herxheimer reaction.
Humans ; Leukocytosis* ; Meningitis, Bacterial ; Mycobacterium ; Tuberculoma ; Tuberculosis, Meningeal*

PURPOSE: Topiramate is a novel antiepileptic drug, and is known to act as a glutamate receptor antagonist. Excitotoxicity by glutamate is also advocated as an arm of brain injury in bacterial meningitis. We sought to delineate whether topiramate could attenuate brain energy depletion during bacterial meningitis by near infrared spectroscopy monitoring. METHODS: Meningitis was induced by intracisternal injection of 108 colony forming units of Escherichia coli. Topiramate at a dose of 50 or 100 mg/kg was given to the piglets 30 minutes before the induction of meningitis. The piglets in the meningitis control group were not given topiramate. Cerebral blood volume, cerebral blood flow, and brain cell energy state were monitored for 6 hours by near infrared spectroscopy. RESULTS: 100 mg/kg of topiramate significantly attenuated the increase in intracranial pressure and leukocyte count in the cerebrospinal fluid during study period. Although statistically insignificant, there was a trend of decrease in cerebral blood volume as indicated by total hemoglobin and cerebral blood flow as indicated by oxidized hemoglobin. Deduced hemoglobin in the meningitis was attenuated by topiramate. Topiramate did not significantly affect the brain energy state as indicated by cytochrome aa3 during the 6 hours after the induction of meningitis. CONCLUSION: 100 mg/kg of topiramate significantly attenuated the inflammatory response in experimentally induced bacterial meningitis. However, there was no significant effect of topiramate on the brain cell energy metabolism during the early phase of experimental bacterial meningitis.
Arm ; Blood Volume ; Brain Injuries ; Brain* ; Cerebrospinal Fluid ; Electron Transport Complex IV ; Energy Metabolism* ; Escherichia coli* ; Escherichia* ; Glutamic Acid ; Intracranial Pressure ; Leukocyte Count ; Meningitis ; Meningitis, Bacterial ; Meningitis, Escherichia coli* ; Receptors, Glutamate ; Spectrum Analysis ; Stem Cells