Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis RegistryReport as inadecuate




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Background

Childhood Meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis.

Methodology and Principal Findings

During the 32 year period, 2477 cases of probable bacterial meningitis BM were collected from the Meningitis Registry MR. Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO version 3.4.3-CDC-Atlanta and SPSS version 15.0 - Chicago software. Statistically significant p<0.05 variables were included in a conditional backward logistic regression model. A total of 838 63.0% attributed to Neisseria meningitidis, 252 18.9% to Haemophilus influenzae, 186 14.0% to Streptococcus pneumoniae and 55 4.1% due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash OR 22.36, absence of seizures OR 2.51, headache OR 1.83 and negative gram stain result OR 1.55 with a Positive Predictive Value PPV of 96.4% 95%CI 87.7–99.6. For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash OR 13.62, positive gram stain OR 2.10, coma OR 3.11, seizures OR 3.81 and peripheral WBC≥15000-µL OR 2.19 with a PPV of 77.8% 95%CI 40.0–97.2. For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash OR 13.61, age≥1year OR 2.04, absence of headache OR 3.01, CSF Glu<40 mg-dL OR 3.62 and peripheral WBC<15000-µL OR 1.74 with a PPV of 58.5% 95%CI 42.1–73.7.

Conclusions

The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.



Author: Maria Karanika, Vasiliki A. Vasilopoulou, Antonios T. Katsioulis, Panagiotis Papastergiou, Maria N. Theodoridou, Christos S. Hadj

Source: http://plos.srce.hr/



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