Pediatric bacterial meningitis in southern China: analysis of 838 cases.

Abstract

Objective: This work aims to study the clinical features and risk factors of children with bacterial meningitis (BM) in southern China.

Methods: Clinical data of children with BM between 2012 and 2018 from one national center were analyzed retrospectively.

Results: A total of 838 patients (male/female = 1.8:1) were enrolled, with 90.6% under 1 year old. Common symptoms included fever, seizure, lethargy, vomiting, anorexia, poor feeding, and irritability. Most patients initially exhibited typical cerebrospinal fluid (CSF) changes of BM, including elevated white blood cell count, increased protein levels, and decreased glucose concentration. Some initially atypical cases showed typical changes after about 1 week. Furthermore, 38.7% of the patients had positive bacterial cultures of blood or CSF, with Streptococcus agalactiae, Escherichia coli, and Streptococcus pneumoniae commonly seen. Moreover, 92.0% of the patients were graded five Glasgow outcome scale (GOS) points at discharge. Differences in symptoms, pathogens, CSF results, brain MRI, and GOS points were observed across age groups (neonate [29 days, 12 months) and aged ≥12 months). Fatality rate was 1.9%, and 10.7% of survivors had neurological sequelae. Recurrent BM was rare (1.6%) but notable in patients with CSF fistula or immunodeficiency. Risk factors for intensive care unit admission, brain parenchymal involvement, subdural effusion, and hearing impairment were identified.

Conclusion: Most pediatric BM patients in southern China were under 1 year old, with more distribution in male patients and some age-related differences in clinical features and outcomes. Recurrent BM is rare but more likely in patients with conditions such as CSF fistula or immunodeficiency. Most patients have favorable outcomes, with a low fatality rate and around 10% of the survivors experiencing neurological sequelae. Several clinical risk factors were identified.