Clinical Profile And Outcome Of Pediatric Bacterial Meningitis: A Prospective Study From A Tertiary Institute In Central India

Abstract

Introduction:

Acute bacterial meningitis (ABM) is a critical condition characterized by inflammation of the leptomeninges due to bacterial infection in the subarachnoid space, leading to severe complications and high morbidity. This study aims to determine the incidence, etiological profile, and complications of ABM in children aged one month to five years in Central India.

Methods

This prospective study was conducted from November 2022 to October 2023 at a tertiary care hospital in Central India. Children aged 1 month to 5 years with suspected meningitis based on clinical features were included. Diagnosis was confirmed through lumbar puncture and cerebrospinal fluid (CSF) analysis, including biochemical tests, cell counts, staining, culture, and latex agglutination test (LAT).

Results

Out of 1560 children admitted, 160 were suspected of having meningitis, and 57 cases were confirmed as ABM. The highest incidence (59.6%) was in the 3 to 12 months age group, with a male to female ratio of 2:1. LAT showed 82.45% positivity, CSF biochemistry was positive in 63% of cases, Gram staining in 8.7%, CSF culture in 3.5%, and blood cultures in 17.5%. The pathogens identified included Group B Streptococcus (45.6%), Streptococcus pneumoniae (21%), and Haemophilus influenzae (10.5%). Complications during hospitalization included seizures (45.6%), increased intracranial pressure (28%), and coma (10.5%), with a case fatality rate of 10.5%. Follow-up visits revealed sequelae such as seizures (38%), cranial nerve palsies (31%), and developmental delays (26.2%).

Discussion

The study reaffirms the high prevalence of ABM in Central India, with a significant burden on infants aged 3 to 12 months. The predominant pathogen was Group B Streptococcus, contrasting with higher prevalence of Streptococcus pneumoniae and Haemophilus influenzae in developed countries. The high rate of complications and case fatality rate highlights the need for improved diagnostic and therapeutic strategies.

Conclusion

The study underscores the critical need for enhanced vaccination, early diagnosis, and appropriate antibiotic use to manage ABM effectively. Comprehensive follow-up care is essential to mitigate long-term complications.