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Bacterial meningitis is a serious problem in pediatric clinics and, therefore, needs urgent and empirical chemotherapy. We investigated 1,116 cases of empirical chemotherapy of patients aged older than 4 months from 1997 through 2008 by sending questionnaires. A single antibiotic treatment was carried out in less than 30% of the cases throughout the years, whereas the combination of two antibiotics had been practiced in more than 70% of the cases. The main antibiotics used were cephalosporins, carbapenems, and ampicillin. Combinatory use of ampicillin and cephalosporin was carried out in 74.7-82.7% of cases in 1997-2000, but sharply declined thereafter to 0-13.8% in 2004-2008. However, the combination of carbapenem and cephalosporin compensated for the decline, increasing from 3.8-6.6% in 1998-1999 to 79.5-89.9% in 2005-2008. The breakdown in the use of cephalosporins, carbapenems, and ampicillin in two-drug combinatory therapy was as follows. (i) Use of cefotaxime was 61.8-75.3% in 1997-2001, but decreased to nearly 50%, equivalent to the level of ceftriaxone use in 2003-2008. (ii) Use of ampicillin dropped from 74.7-92.3% in 1997-2000 to 4.6% in 2008, and this decreased level was compensated for by the use of carbapenems. Overall, combinatory chemotherapy of the third-generation cephalosporins and carbapenems seems to be practical. The discussion in this report includes the difference between Japan and the United States in the prevalence of the causative agents and the use of antibiotics. These studies provide information on trends in the treatment of children's meningitis in Japan and will be useful for the design of future empirical chemotherapy. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss the epidemiology of meningococcal diseases caused by Neisseria meningitidis among children in the U.S. The authors divided the strains of the etiologic agent into serogroups based on the virulence of the polysaccharide capsules of the bacteria. They concluded that the incidence of meningococcal diseases is 10 times higher in infants compare to adults from 2003 to 2007.

The article focuses on the treatment of three children with multidrug-resistant (MDR) Acinetobacter baumannii meningitis referred to the Department of Pediatrics in Ankara University in the U.S. It outlines the condition and symptoms of the infection as well as the use of intravenous and intrathecal colistin in treating the disease. It notes the effectivity of the treatment and suggests that intravenous and intrathecal colistin are potentially safe therapeutic option for childhood MDR.

OBJECTIVE: We aimed to determine the risk of SBIs in febrile infants with influenza virus infections and compare this risk with that offebrile infants without influenza infections. PATIENTS AND METHODS: We conducted a multicenter, prospective, cross-sectional study during 3 consecutive influenza seasons. All febrile infants ⩽60 days of age evaluated at any of 5 participating pediatric EDs between October and March of 1998 through 2001 were eligible. We determined influenza virus status by rapid antigen detection. We evaluated infants with blood, urine, cerebrospinal fluid, and stool cultures. Urinary tract infection (UTI) was defined by single-pathogen growth of either ⩾5 × 104 colony-forming units per mL or ⩾104 colonyforming units per mL in association with a positive urinalysis. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the 4 above-mentioned bacterial infections. RESULTS: During the 3-year study period, 1091 infants were enrolled. A total of 844 (77.4%) infants were tested for the influenza virus, of whom 123 (14.3%) tested positive. SBI status was determined in 809 (95.9%) of the 844 infants. Overall, 95 (11.7%) of the 809 infants tested for influenza virus had an SBI. Infants with influenza infections had a significantly lower prevalence of SBI (2.5%) and UTI (2.4%) when compared with infants who tested negative for the influenza virus. Although there were no cases of bacteremia, meningitis, or enteritis in the influenza-positive group, the differences between the 2 groups for these individual infections were not statistically significant. CONCLUSIONS: Febrile infants ~60 days of age with influenza infections are at significantly lower risk of SBIs than febrile infants who are influenza-negative. Nevertheless, the rate of UTI remains appreciable in febriIe, influenza-positive infants. [ABSTRACT FROM AUTHOR]

Vaccines against Haemophilus influenzae type B (HI) and Streptococcus pneumomae (SP) have dramatically reduced the incidence of bacterial meningitis (due to both HI and SP) and epiglottitis (due to HI) in childhood. The effects of these vaccines on other conditions, however, are less clear. We report an analysis of the effect of serial deployment of various HI and SP vaccines over a 25-year period, involving an examination of over half a million pediatric hospitalizations occurring in Army hospitals worldwide. We show that, in marked contrast to the reduction in the number of meningitis and epiglottitis cases, the disease burden of orbital and facial cellulitis--conditions oft attributed to HI and SP--did not diminish. [ABSTRACT FROM AUTHOR]

Neisseria meningitidis is the most common cause of meningitis in children aged 2-18 with a mortality rate ranging from 4-40% and substantial morbidity in 11-19% of survivors. Of the four serogroups of Neisseria meningitidis, serogroups B and C are the most common causes in the United States, with serogroup C causing most disease among adolescents, a population at risk for invasive meningococcal disease. The meningococcal polysaccharide vaccine was developed in response to increasing rates of bacterial meningitis among military recruits. With widespread use of the vaccine in the military, there was a dramatic decreased incidence in invasive meningococcal disease. However, there may be limitations to the polysaccharide vaccine including lack of durable protection, lack of induction of T-cell-dependent immune response, and lack of immunogenicity in children less than 2 years of age. Based on the success of other conjugate vaccines in pediatrics, a new conjugate polysaccharide vaccine, Menactra®, has been approved by the Food and Drug Administration and recommended for routine vaccination in adolescents by the Advisory Committee on Immunization Practices. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the serogroups of pneumococci that caused bacteremia or meningitis in children from 1981 to 1998 in Boston, Massachusetts. Methodology; Results of the study; Discussion.

Presents the 1991 Metropolitan Atlanta Developmental Disabilities Surveillance Program report indicating that bacterial meningitis and child battering were the leading postnatal causes of developmental disabilities in children aged 3-10 years. Types of developmental disabilities; Severity of different types of developmental disabilities.

Abstract. Objective. We report the clinical features and cerebrospinal fluid (CSF) laboratory values for 277 children younger than 24 months of age with aseptic meningitis who were prospectively evaluated at three Baltimore hospitals between July 1986 and December 1990. A major objective was to define the incidence, etiology, and outcome of neurologic complications occurring during the acute illness. Methods. Cases were identified by surveillance in the ambulatory care departments of each of the three hospitals, pertinent historical and clinical data were obtained by interview of the parents and by review of the medical records, initial CSF laboratory values were recorded, and appropriate specimens were submitted to determine the viral etiology. A subset of 216 children who participated in a long-term natural history study were followed periodically with neurologic examinations and formal neurodevelopmental testing. Results. Most cases occurred in very young infants; 63.5% of patients were 8 weeks of age or younger, and 84.1% were younger than 16 weeks of age. In this very young cohort, the dominant symptoms were fever and irritability; only 8.7% had evidence of meningeal irritation at the initial examination. The acute illness was complicated by either complex seizures, physical evidence of increased intracranial pressure, or coma in 25 (9.0%) cases. Within the age group under study, these complications were each significantly more likely to occur in patients older than 12 weeks of age than in younger infants. The risk of neurologic complications was similar among infants infected with group B coxsackieviruses and echoviruses, the... [ABSTRACT FROM AUTHOR]

Abstract. Enterovirus 71 (E-71) infection was first reported in 1974 in the United States; subsequent outbreaks were reported in worldwide distribution. In the summer of 1977, we identified 12 patients, mostly children, with E-71 infection. The striking feature of this outbreak is the occurrence of two cases with polio-like paralytic disease. Other diseases associated with E-71 included aseptic meningitis, meningoencephalitis, respiratory disease, gastroenteritis, and hand-foot-mouth disease. The spectrum of illness observed in our community was compared to that seen in other outbreaks. It is suggested that the significance of E-71 lies in its neuropathogenic potential. Pediatrics 67:489-493, 1981; enterovirus infection, enterovirus 71, paralysis, polio-like dis. ease. [ABSTRACT FROM AUTHOR]

Abstract. Two cases of invasive Haemophilus influenzae type B disease (meningitis and cellulitis) occurred during a 60-day period among 69 children (median age 18 months) attending a day care center in Fresno, Calif. Nasopharyngeal colonization rates for H influenzae type B were 49% in the children, 8% in family contacts of culture-positive children, and 0% in staff. Colonization by H influenzae type B was infrequent in two control populations of children: those attending day care centers in Fresno without known H influenzae type B disease, and healthy children not enrolled in day care centers. The isolates from the children in the index day care center were inhibited in vitro by low concentrations of trimethoprim-sulfamethoxazole, but therapy with this combination for seven to ten days was ineffective in eliminating H influenzae type B carriage in 73% of 26 treated children. In a second clinical trial, treatment for four days with rifampin eradicated H influenzae type B carriage in 14 of 16 culture-positive individuals, whereas carriage persisted in 6 of 7 children whose families initially declined rifampin therapy (chi[sup 2, sub c] = 8.5, P < .004). When systemic H influenzae type B infection occurs in a closed population of young children, the risk of serious illness among contacts may be appreciably higher than in similar age children in the general population. Our data indicate that rifampin is effective in this clinical setting, and support the need for a larger, controlled clinical trial. Pediatrics 63:397-401, 1979, Haemophilus influenzae type B, meningitis, rifampin, trimethoprim-sulfamethoxazole, day care center. [ABSTRACT FROM AUTHOR]

The article focuses on the issue surrounding the use of meningococcal vaccines for infants and children. The author mentions that the Advisory Committee on Immunization Practices (ACIP) has been evaluating the efficacy of the vaccines due to the prevalence of meningococcal disease. He mentions that among the criteria being considered by ACIP is the changing epidemiology of the disease, as well as the decline in its prevalence in the U.S.

We report the first pediatric case of Mollaret meningitis in an adolescent female with acute lymphoblastic leukemia in remission. This patient had signs and symptoms consistent with meningitis, with three episodes over a 3-month period. Human herpesvirus 6 (HHVL.6) was identified during her last episode from polymerase chain reaction assay of a cerebrospinal fluid specimen. She was treated successfully with foscarnet, after which HHV-6 was undetectable in her cerebrospinal fluid. [ABSTRACT FROM AUTHOR]

Opinions. Asserts that children vaccinated against Haemophilus influenza type b with suspected meningitis should not be treated with steroids. Occurrence of nonbacterial meningitis during summer and enterovirus season; Potential side effects of dexamethasone in treating Streptococcus or Neisseria meningitidis; Individualization of patient care; Expansion in immunization programs.

The article presents a report from the U.S. Centers of Disease Control and Prevention regarding the decision by the Advisory Committee on Immunization Practices (ACIP) not to recommend routine quadrivalent meningococcal conjugate vaccination (MCV4) for children aged 2-10 years who are not at risk for the disease. A summery of ACIP deliberations over the issue and the rationale behind its decision are analyzed. The continued recommendations for MCV4 administration to those children at risk, which includes travelers to nations where the disease is hyperendemic or epidemic, children who have terminal deficiencies, and children who have anatomic or functional asplenia, are explained.

This article presents news from the U.S. Centers for Disease Control and Prevention (CDC). In this article the CDC presents revised recommendations on vaccination of all children aged 11-18 years with meningococcal conjugate vaccine (MCV4). The Advisory Committee on Immunization Practices (ACIP) has added routine vaccination of children aged 11-12 at the annual physical examination. The ACIP still recommends routine vaccination for people 19 to 55-years-old who are at increased risk for infection either because they live in a dormitory or because they could be exposed through work, travel or military service.

The author comments on the study "Variations in the Use of Intracranial Monitoring and Mortality in Critically Ill Children With Meningitis in the U.S.," by O. Odetola, J. Tilford and M. Davis in a 2006 issue of "Pediatrics." He expresses disappointment with the study for not demonstrating benefits as was achieved by the use of ventilatory support. The drawbacks of the study are cited.

Reports on the recent licensing of a new meningococcal conjugate vaccine which is expected to drastically reduct the prevalence of invasive meningococcal disease in the United States; New recommendation from the CDC that calls for children aged 11 and 12 years, teens entering high school and college freshmen living in dorms be inoculated; Why the new vaccine is an improvement over the old; Target populations which will be the 11- and 12- year-old patients; Announcement by the CDC which immediately caused a vaccine shortage as maker Sanofi Pasteur can only make around 5 million doses this year.

Provides information on a report on the incidence of Haemophilus influenzae type b (Hib) disease. Hib as the common cause of bacterial meningitis in preschool-age children in the United States; Race-adjusted incidence of invasive Hib disease; Protection of children from invasive Hib disease; Role of physicians; Appropriate age for vaccination.

The article reports that MenB vaccine from Novartis AG has shown potential to protect infants against meningococcal B infections. The phase II trial showed a protective immune response after a series of 3 immunizations with MenB starting at 2 months of age. It informs that 72% of meningitis infections in Europe is caused by the meningococcal B strain. It reflects that if B antigen could be made sufficiently antigenic to provoke a good antibody response, it would be advantageous to have it included in the U.S. vaccines. It reports that the U.S. polysaccharide vaccines have not proven to be beneficial in children less that 2 years old.

The article reports on the importance of vaccination against Streptococcus pneumonia in children with cochlear implants. It mentions that according to the U.S. Food and Drug Administration that at least one child with cochlear implant died from bacterial meningitis because of inadequate immunization against the microorganism. It is also mentioned that children with implanted devices are at high risk for invasive pneumococcal disease and Haemophilus influenzae and should be vaccinated.

The article reports that the U.S. Food and Drug Administration (FDA) has permitted in January 2008 the use of Menactra for the vaccination against bacterial meningitis of children ages 2 to 10 years old. Prior to the action of FDA, the vaccine was approved for people ages 11 to 55 years old only. Menactra, a product of Sanofi Pasteur Inc., offers protection against Neisseria meningitidis bacteria.

The article reports on the results of a 2002 investigation conducted by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention suggesting that cochlear implants increase meningitis risk in children. It was found that the incidence of bacterial meningitis within the first two years of implantation was as much as 30 times greater than in the general population.

Focuses on moxalactam, a class of betalactam antibiotics marketed as Moxam in the U.S., for treating childhood meningitis. Mechanism of the drug; Advantages of moxalactam over other treatments for childhood meningitis; Side effect of the drug.

Reports on the daily use ceftriaxone (Rocephin) to treat children with bacterial meningitis. Initial dosage; Adverse reactions.