V.5) HOSPITAL OUTCOME OF BACTERIAL MENINGITIS IN
CHILDREN
We recorded in our study 1 death representing 2.4 % of all the
children admitted for bacterial meningitis. This is very low compared to that
of Nguefack et al at YGOPH in 2014 with 17 deaths that is 53.1 % [3].
Koko in Gabon had much higher with 62 % [65].
However, our result had similarities with that of Wee LY et al in
Singapore who recorded 6 % of death cases [71]. Chandran had a
much lower percentage of 0.4% [6]. This low record of ours is
probable due to the early death of patients that were suspected of having
meningitis at entry, who died before any confirmatory examination notably
lumbar puncture could be performed probably because they presented with
contraindications.
We found that respiratory distress was the most common
complication of bacterial meningitis during hospitalization at 20.9 % at the
general pediatric unit at the YGOPH, followed by anemia with 16.3 %. We also
noted dehydration and status epilepticus as complications of meningitis both at
11.6 %. It is different from what Franco-Paredes and Nguefack had both with
seizure disorders and status epileticus as their main complication of bacterial
meningitis at 37 % and 54.7 % respectively[3][60].This result
can be explained by the fact that Streptococcus pneumoniae was the
predominant pathogen found , thus it is obvious for these patients to have
respiratory problems. The anemia can be justified by the fact that there must
have been an associated disease like malaria which is known to cause anemia
.Dehydration being present as a complication can be explained by the symptom of
fever, where fluid tends to be lost through sweat.
Hydrocephalus was the most common sequelae in the study at 9.3
% which is contradictory to that of Nguefack et al who had psychomotor
regression as the highest sequelae at 2.9 %3]. Sile had at the
Garoua provincial hospital 1 case of paraplegia [67].
Among the 4 patients that had hydrocephalus from our study, 2
had neurosurgery as treatment. This is probably due to poor financial
conditions that disabled the 2 others from benefiting from the treatment.Among
patients who had psychomotor regression (1)
51
and tetra paresis (2), 2 had physiotherapy done for their
rehabilitation, explained by probable poor financial conditions for the one
that could not afford for the service.
? LIMITATIONS OF THE STUDY
We encountered various difficulties of which some are
naturally found in every retrospective study that is: files with incomplete
information, files that were not exploitable, and many files were lost from the
archives because most of these files didn't return when they left this service
for another unit in the hospital. There was a problem of uniformity among the
health personnel too in taking clinical observations notably for the
diagnosis.
Also considering the fact that there were a limited number of
pathogens available, the antibiogramme sensitivity analysis could not be
done.
CONCLUSION
At the end of this study, the different specific objectives
have been attained. We can therefore come to the conclusion that:
> The incidence of bacterial meningitis in children at the
YGOPH is 0.3%.
> The most common etiologies responsible for bacterial
meningitis in YGOPH are Streptococcus pneumoniae at 63% and
Neisseria meningitidis at 25 % and presented more in children <12
months of age .
> Most children presented at the consultation with fever as
the predominant symptom at 95.3%, followed by convulsions at 60.5 %.On clinical
examination, neck stiffness was the most common sign at 20.9%, followed by
meningeal signs at 16.3%.
> The mortality was 2.4 %, and 97.6 % of patients left the
hospital alive .Among the 97.6 % patients that left the hospital alive, 61.5%
had neurological complications.
RECOMMENDATIONS
Our conclusions above enable us to do the following
recommendations;
? TO THE MINISTRY OF PUBLIC HEALTH
- Re-enforce vaccination campaigns in children all over the
country.
52
? YAOUNDE GYNECO-OBSTETRIC AND PEDIATRIC
HOSPITAL
- Re-enforce information towards infectious diseases especially
on meningitis.
- Re-enforce information, education and communication on
vaccinations of children.
53
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60
APPENDIX A : AUTORISATION OF THE YGOPH
APPENDIX B : QUESTIONNAIRE
A. IDENTIFICATION OF THE CHILD
Questionnaire N° File N°
Date of admission Weight
Date of birth Age
Sex M F
School level: pre-school primary secondary High school
Origin
Type of admission:CME/FCB Referred
Reason for admission
B. PAST HISTORY OF THE CHILD
1) Immunization calendar up to date yes No
i) If No, which vaccines lacks?
2) P24 statusyes No
i)If yes on treatment
3) Underlying disease yes No
i) If yes what disease
ii) Undergoing treatment for the
disease
4) Any contact with someone with meningitis before admission? Yes
No
C. INFORMATION ON THE PARENT / GUARDIAN
i)MOTHER
Age (years):<20 (20-34) >34
Profession: Liberal Non-liberal Student or pupil Not employed
Level of education: primary secondary higher education
illiterate
Matrimonial status: married single
Past medical history Region of
origin ..
ii)FATHER
Age (years):<20 (20-34) >34
Profession: Liberal Non-liberal Student or pupil Not employed
Level of education: primary secondary higher education
illiterate
Matrimonial status: married single
Past medical history Region of
origin ..
D. MANIFESTATION OF THE DISEASE ON THE CHILD
Convulsion yes No
Fever yes No
Kerning sign yes No
Brudzinski'ssign yes No
Nuchal rigidity yes No
Lethargy yes No
Bulging fontanelle yes No
Feeding problems yes No
Behavioural changes yes No
Respiratory manifestations yes No
i) If Yes which one
Digestive manifestations yes No
Others
E. LABORATORY FINDINGS ON CSF
1) Macroscopic examination of the
CSF/Appearance ..
2) CSF Biochemistry characteristics
Proteins g/dl
Glucose mmol/L
3) Cytology aspect of the CSF
WBC count cells/ml
RBC count cells/ml
4) Gram stain, bacteria isolated yes No
i) If yes what findings
5) Any CSF culture done yes No
If yes which growth was obtained
6)Soluble Antigens yes No
i)If Yes
F. OUTCOME DURING ADMISSION
Any complications yes No
i) If any, which one(s)
ii) Treatment received for the
complications
ii) Mortality yes No
Comorbidities: yes No .If yes which one(s)
G. EVOLUTION
cured Died Discharged against medical advice
H. TREATMENT RECEIVED i) Antibiotherapy
cephalosporins .Others
ii)Adjuvant therapy
Steroids anticonvulsant antipyretics
Iii) Fluid
I. PREVENTIVE MEARSURE
Preventive measures proposed? Yes No
i) If yes, which one?
Education on vaccination chemoprophylaxis of child at risk
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