PATTERN OF PATHOGENS IN CHILDHOOD BACTERIAL MENINGITIS BEYOND THE NEONATAL PERIOD AS SEEN IN LAGOS

Abstract

Acute bacterial meningitis is one of the major causes of morbidity and mortality in children. The
present study was carried out with the aim of determining the different bacterial pathogens
causing meningitis in children aged two months to 12 years presenting at the emergency rooms
of two tertiary centres in Lagos. It was a prospective, descriptive and cross-sectional study that
lasted eight months between the months of January and August 2007. Children, who met set
criteria for inclusion were recruited into the study and following informed consent, had lumbar
punctures done.

The cerebrospinal fluid (CSF) samples were subjected to microbiologic assessment as well as
biochemical tests. In addition to these all the patients had latex agglutination tests (LAT) done.
Sixteen (6%) of the 267 patients in the study were diagnosed with meningitis giving an overall
prevalence of 2.62 per 1000 emergency room admissions. The male to female ratio was 3:1. The
prevalence at LUTH was about two and a half times that in LASUTH but the difference was not
statistically significant (4.25/1000 Vs 1.76/1000, 2 = 3.70, p = 0.06). LAT identified the
pathogen in 93.8% of cases and Gram stain was the sole method of identification in one patient.
Majority of patients (72.3%) had been exposed to antibiotics before presentation in hospital. No
organism was isolated by CSF culture in the present study. There were more children diagnosed
with meningitis in the younger age groups (87.5% of meningitis was in children ≤ five years).
Streptococcus pneumoniae was the most prevalent causative organism accounting for 50% of
cases.
The case fatality rate (CFR) was relatively high (31.25%). Of the 11 survivors, 27.3% had
neurologic sequelae. In conclusion, a relatively low prevalence of meningitis was observed in the
current study. The high rate of sterile cultures obtained may have in part been due to the high
rate of antibiotic use. The use of latex agglutination tests is recommended as this would improve
on the prompt diagnosis of meningitis especially in patients who have been exposed to
antibiotics before presentation in hospital.

PATTERN OF PATHOGENS IN CHILDHOOD BACTERIAL MENINGITIS BEYOND THE NEONATAL PERIOD AS SEEN IN LAGOS