[P3-18] Clinical Profiles and Risk Factors of Acute Bacterial Meningitis in Children with Febrile Fits in Myanmar
[Purpose] To identify clinical profiles and risk factors of acute bacterial meningitis (ABM) in children with febrile fits.
[Methods] A retrospective study included children aged 1 month to 12 years, admitted to Yangon Children Hospital with febrile fits from January to December 2012. ABM was defined by CSF profile with polymorphonuclear cells > 5/mm3, protein > 45mg/dl, reduced CSF glucose and/or positive Gram stain or culture.
[Results] Of eighty four children, 31 cases were diagnosed as ABM. Most (51.6%) were under one year and 61.3% were males. Most presented with lethargy/irritability. Half of children had 2 – 5 seizures, 61.2% occurred 2nd to 7th day fever with duration < 15 minutes in 74.1%, generalized seizure in 83.8% and 29% had post ictal deficit. Thirteen percent behaved like simple febrile seizures. Seventeen children had low GCS. 26.5% had meningeal signs. Neutrophil leucocytosis was seen in 61.2% and 32.2% had high CRP. Regarding CSF examination, 80% had clear CSF, 4% had CSF cell count 0-4, 8 % had 5-10, 76% had 11 -100, 4.8% had 101-500 and 8% had >500 respectively. CSF protein level was increased in 68% with reduced CSF sugar in 40%. Altogether eight predictors i.e. GCS, meningeal irritation, increased total white cell count, neutrophil leucocytosis , high CRP, bulging anterior fontanel, upper motor neuron signs and cranial nerve palsy are most significant risk factors to become ABM.
[Conclusion] In resource poor settings like Myanmar, the availability of a combination of easy-to-obtain parameters can significantly help physicians in diagnosis of ABM.
[Methods] A retrospective study included children aged 1 month to 12 years, admitted to Yangon Children Hospital with febrile fits from January to December 2012. ABM was defined by CSF profile with polymorphonuclear cells > 5/mm3, protein > 45mg/dl, reduced CSF glucose and/or positive Gram stain or culture.
[Results] Of eighty four children, 31 cases were diagnosed as ABM. Most (51.6%) were under one year and 61.3% were males. Most presented with lethargy/irritability. Half of children had 2 – 5 seizures, 61.2% occurred 2nd to 7th day fever with duration < 15 minutes in 74.1%, generalized seizure in 83.8% and 29% had post ictal deficit. Thirteen percent behaved like simple febrile seizures. Seventeen children had low GCS. 26.5% had meningeal signs. Neutrophil leucocytosis was seen in 61.2% and 32.2% had high CRP. Regarding CSF examination, 80% had clear CSF, 4% had CSF cell count 0-4, 8 % had 5-10, 76% had 11 -100, 4.8% had 101-500 and 8% had >500 respectively. CSF protein level was increased in 68% with reduced CSF sugar in 40%. Altogether eight predictors i.e. GCS, meningeal irritation, increased total white cell count, neutrophil leucocytosis , high CRP, bulging anterior fontanel, upper motor neuron signs and cranial nerve palsy are most significant risk factors to become ABM.
[Conclusion] In resource poor settings like Myanmar, the availability of a combination of easy-to-obtain parameters can significantly help physicians in diagnosis of ABM.