Search

Summary: Neonatal meningococcal meningitis are rare, but serious by their high mortality and squealer of severe psychomotor and sensor neural. We report four cases of meningococcal meningitis collected in neonatology and neonatal resuscitation service CHU Hassan II of Fez, from 1st January 2003 to 31st December 2006. The aim of our work is to reassess the frequency of this pathology and analyze its transmission in the neonatal period. Neonatal meningococcal meningitis accounts for 12% of all neonatal meningitis collected in our service and 0.7% of neonatal infections during the study period. Three patients aged respectively H2, H17 and j2 life so the transmission path is most likely the placenta. The fourth patient is older than 12 days, which suggests the likelihood of exogenous transmission. The clinical picture is variable and atypical disorders tone is found in three patients representing the most constant sign. Direct examination of the CSF has identified the germ in three cases and the fourth by soluble Ag. The third generation cephalosporins were the treatment of choice for our patients. The evolution was favorable and complications are encountered in only one patient. [Copyright &y& Elsevier]

Abstract: Objective: Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine the factors associated with hospital mortality of children with pneumococcal meningitis. Methods: We conducted a retrospective study of 73 cases of childhood pneumococcal meningitis admitted in 4 teaching hospitals in the center of Tunisia during a 8-year period (1995–2002). Results: Hospital mortality was 13.7% (10 of 71 patients), and neurologic sequela were observed in 34.5% of survivors. Based on univariable analysis, five variables were associated with the outcome: Pediatric Risk of Mortality score (p < 0.001), coma (p =0.0009), use of mechanical ventilation (p =0.0001), convulsions (p = 0.0449), and shock (p =0.0085). In multivariable analysis, only 2 factors were independently associated with inhospital mortality: Pediatric Risk of Mortality score and the use of mechanical ventilation. 11.8% of pneumococcal isolates were intermediate and resistant to penicillin. Non-susceptible pneumococcus strains to penicillin and the use of steroids were not associated significantly with the mortality rate. Conclusions: Pneumococcal meningitis remains a devastating childhood disease. Two variables were independently associated with the in-hospital death in our series (high Pediatric Risk of Mortality score, and the use of mechanical ventilation). According to these data we may recommend the inclusion of vaccination against streptoccoccus pneumonia in the children immunization program in Tunisia. [Copyright &y& Elsevier]

Abstract: Streptococcus pneumoniae (Sp) is an important cause of morbidity and mortality among paediatric infectious diseases. The aim of this study is to analyse specifical data on Sp meningitis out of the Bacterial Meningitis (BM) French Surveillance Network about mean age of BM cases and clinical features. Overall 367 Sp BM were reported between January 2001 to January 2004 (sex ratio M/F: 1.3), 69.7% were&#60;2 years old, median age 0.8 year (minmax 0–16.8 years). Before two years old children, 94.1% had no medical risk factor and no underlying conditions: on the other hand, after two years old, these factors were reported in 27% cases (P &#60;0.001). Mortality rate was 10.9%. On account of a Sp BM''s pic at five months, data of the BM French Surveillance Network confirm the necessity of an early vaccination. The vaccine administration at two, three, four months with a booster during the second year, recommended in the vaccinal french calendar, seems particularly adapted to the Sp BM in France. [Copyright &y& Elsevier]

Introduction: Les méningites restent un problème préoccupant de la santé au Maroc, malgré les progrès thérapeutiques du fait de la mortalité élevé et des séquelles neurosensorielles. Le but de travail: Analyser le profil épidémiologique, clinique, biologique et la prise en charge thérapeutique des méningites. Matériel et Méthodes: Nous rapportons les résultats d’une étude rétrospective menée au service de pédiatrie durant l’année 2009, colligeant les différents types de méningites. Résultats: Nous colligeons 88 cas, 58 garçons et 30 filles, dont l’âge varie de 3 mois à 14 ans. Cliniquement, 17 malades ont été admis dans un tableau de convulsion avec fièvre, 38 présentaient des taches purpuriques. La ponction lombaire a trouvé un LCR clair chez 32 malades,et purulent chez 41malades. Les méningites bactériennes représentent 75 % des cas. L’étude bactériologique a confirmé 9 cas de méningites à méningocoque, 7 cas à pneumocoque et 1 seule à Hémophilus influenzae. Les méningites virales représentent 25 % des cas. L’évolution été favorable dans la majorité des cas avec 7 cas d’hydrocéphalie, 4 cas d’empyème cérébral, et 2 cas de thrombophlébite cérébrale. On déplore un décès. Conclusion: Les méningites restent fréquentes dans notre contexte d’où l’intérêt de la prophylaxie et de la vaccination. [ABSTRACT FROM AUTHOR]

Summary: Listeriosis is a serious invasive disease which affects mainly pregnant women, newborns and immunocompromised adults. Objective: To analyze specifically the epidemiological and clinical data of the meningitis due to Listeria monocytogenes (Lm), from the French Network of Surveillance of Bacterial Meningitis in childhood. Patients and methods: Patients were aged 0 to 18 years. The diagnosis was based on a combination of a feverish meningeal syndrome and a positive culture of cerebrospinal fluid (CSF) and/or a positive PCR in the CSF and/or positive blood culture associated with a pleiocytose. Results: Among 2539 cases of bacterial meningitis recorded in 6 years (2001 to 2006), 18 cases were due to Lm (0.7 %) (sex ratio M / F : 0.8). The average of age was 2.5 years (median : 0.5 ; ext : 0-15.1). The serotype of Lm was 4B in half of the cases. Most cases have occured in summer and autumn. Two patients presented an acquired or congenital immunodeficiency. Fifty-six percent (n=10) were younger than 1 year, among them, 7 were newborns. The CSF direct microbiologic investigation was suggestive of Lm (Gram positive bacilli) only in two cases, but the culture of CSF was positive for 16 patients and the blood culture was positive for 2 other patients. Three of 18 patients died between 7 and 13 days after admittance : a premature baby of 25 weeks’gestational age, two full-term newborns of 2 days and 1.5 months old. The mortality rate was 16.7 % before the age of 1 year (no death after this age). Conclusion: Meningitis due to Lm remains a rare disease, including in neonatal period. The recent increase of cases in adults requires to maintain vigilance in children especially since direct examination of CSF can rarely allow the diagnosis. [Copyright &y& Elsevier]

Summary: Objective: The group B streptococcal meningitis (GBS) remains an important cause of child''s morbidity and mortality. The purposes of this work were to appreciate the GBS place among the bacterial meningitis, to define clinical and biological factors associated with death and to study the immediate complications. Patients and methods: This study concerned 276 GBS meningitis listed by the observatory of GPIP/ACTIV on the child''s bacterial meningitis in France from January, 2001 to December, 2005. This report is one of the biggest series of child''s GBS meningitis published to this day. Results: The GBS was the third germ in frequency responsible for bacterial meningitis at every age (13 %) : 65 % of the GBS meningitis affected infants less than one month of age, 29 % infants between 1 month and 3 months of age and only 6 % infants more than 3 months of age. The male/female ratio in GBS meningitis was nearly equal (51 % vs 49 %). There was no variation of the GBS meningitis number according to the season. The serotype III was mostly involved in this cohort (81 %) followed by the serotype I (13 %). Statistically we observed a significant decline in the number of early onset meningitis from 2001 to 2004 whereas the number of late meningitis and the total meningitis cases were stable. The biological results mostly present in child''s GBS meningitis were a high CSF protein level (95 %), a CSF neutrophil count more than fifteen percent (90 %), a low CSF glucose level (83.5 %), leukopenia (49 %) or a normal blood level leukocyte (38 %). Eighty three percent of the children affected by GBS meningitis were term infants. However, the prematurity seemed to be a risk factor to develop late meningitis (age between 7 days and 3 months) and very late meningitis (after 3 months) but no early onset meningitis. Prematurity, convulsions, shock, coma, assisted ventilation, high CSF protein level, weak CSF cell level and leukopenia seemed to be factors associated with death in the GBS meningitis. The mortality of the GBS meningitis was still 14 % and the immediate complications were observed in 62 % of cases, the most frequent being convulsions (45 %). Conclusion: The GBS meningitis in children remains a frequent problem in pediatrics despite intra partum antibioprophylaxy and thus must encourage to strengthen the prevention of these meningitis. [Copyright &y& Elsevier]

Summary: Background: Pneumococcal meningitis represents one major cause of morbidity and mortality in children in France. The GPIP/ACTIV (Groupe de Pathologie Infectieuse Pédiatrique and Association Clinique et Thérapeutique Infantile du Val de Marne) set up an active surveillance network to analyze the clinical and biological features of pneumococcal meningitis and the impact of 7-valent pneumococcal conjugate vaccine (PCV7). Methods: From 2001 to 2007, 252 French pediatric wards working with 168 microbiology laboratories enrolled all children (0-18 years old) with bacterial meningitis. Risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. Results: Within the 7 years study period, 832 pneumococcal meningitis were reported among 2951 bacterial meningitis. In 2001 as in 2007, excluding the neonatal period, pneumococal meningitis represented nearly 1/3 of bacterial meningitis without significant decline in the number of reported cases (less than 30% for children under 2 years old). The peak of incidence was at 5 months of age and 61.7% of cases occured in children 2 to 24 months old. PCV7 vaccinated patients represented 154 cases from 2003 to 2007. In the vaccinated population, serotypes were identified in 136 cases. Few vaccine serotypes (VT) were identified (n=18). The most important was serotype 19F (n=8) followed by 6B (n=4) and 14 (n=3). Three vaccine failures (case occurring after complete vaccination) were observed (serotypes 6B, 4 and 19F). Remaining cases (n=118) were mainly due to non vaccine serotypes (NVT): serotypes 19A, 15B/C and 7F. In 2007, the serotype 19A, more often intermediary strains to cytoxin, represented about 20% of cases. Among non vaccinated children, VT decreased between 2001 and 2007 (59/92 in 2001 vs 15/39 in 2007). Case fatality rate was stable around 11.4%. Conclusion: In France, probably because of the insufficient vaccination coverage and the slow implementation of the PCV7, the expected decline in the number of cases of pneumococcal meningitis has not been observed. The impact of PCV7 appeared clearly since only few cases of VT pneumococcal meningitis were reported in vaccinated children. [Copyright &y& Elsevier]