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Journal of Tropical Pediatrics Advance Access published online on August 12, 2008
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmn046
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© The Author [2008]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Pneumococcal Meningitis in Taiwanese Children: Emphasis on Clinical Outcomes and Prognostic Factors

Ming-Han Tsaia,b, Shih-Hsiang Chenc,d, Chih-Yi Hsue, Dah-Chin Yanc,d, Meng-Hsiu Yenc,d, Cheng-Hsun Chiuc,d, Yhu-Chering Huangc,d and Tzou-Yien Linc,d

aDepartment of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan
bGraduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
cDepartment of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
dCollege of Medicine, Chang Gung University, Taoyuan, Taiwan and
eDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Correspondence: Dr Dah-Chin Yan, Division of Taipei Pediatrics, Department of Pediatrics, Chang Gung Children's Hospital, No. 199, Tun-Hua North Road, Taipei 105, Taiwan. Tel.: 886-2-27135211 ext 3381, Fax: 886-2-25457279. E-mail <silvia{at}ms13.hinet.net>


  Abstract

Pneumococcal meningitis causes high morbidity or mortality in childhood despite the progress in medicine. Children with pneumococcal meningitis were identified and retrospectively reviewed. Forty-nine children were eligible, with mortality in 24.5% of all and neurological sequelae in 40.5% of survivors. In the analysis of clinical profiles, ventilator support (p = 0.001), septic shock (p < 0.001), multiple organ failure (p < 0.001) and lower cerebrospinal fluid (CSF) leukocyte count (p = 0.001) were more frequently found in non-survivors. Besides, CSF protein (p = 0.006) was higher in survivors with neurological sequelae. Initial dexamethasone usage and disease severity did not affect the occurrence of neurological sequelae. Multivariate logistic regression analysis revealed that CSF leukocyte count ≤200 mm–3 (p = 0.013) and protein level ≥330 g l–1 (p = 0.022) were significantly risk factors associated with poor outcomes, and physicians should be cautious if such conditions occur.

Key Words: meningitis • Streptococcus pneumoniae • children • outcomes


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