Clinical Analysis Of Purulent Meningitis In Children And Risk Factors For Adverse Prognosis

ObjectiveTo analyze the clinical data of children with purulent meningitis in order to explore the risk factors predisposing to poor prognosis of childhood purulent meningitis.MethodHospital based retrospective study involved children(1 month to 16 years)with diagnosis of purulent meningitis who were hospitalized at the Pediatric Medical Center of our Hospital from July 1,2008 to July 1,2017.Data were collected and grouped according to the Glasgow score criteria at the time of discharge collected cases were divided into well-prognosis group and poor-prognosis group According to Glasgow outcome score(GOS).The factors of general conditions,clinical manifestations,auxiliary examinations,complications,and medications before and after admission were compared,that may affect the prognosis.At first,factors were tested for normality,statistical descriptions of measurement data that correspond to normal distribution were expressed as mean±standard deviation.The median of measurement data that didn’t meet the normal distribution and interquartile range report were counted.Statistical descrptions were expressed in terms of frequency and composition ratio,for univariate analysis the measurement data that met normal distribution and homogeneity of variance t-test was used,for those data that didn’t meet criteria the previous report was converted into count data or ranked as sum test,the count data are chi-square test and firsher’s exact test.The univariate analysis of significant factors as an independent variable using the prognosis as dependable variable,multivariate unconditional logistic regression analysis with statistical significance at both sides P<0.05.Results1.General conditions:222 cases met criteria and were included in the study.High prevalence of purulent meningitis found in younger children ≤1 year(167 cases 75.23%),1-3 years were 9.01%.Male 144 cases(64.87%),male to female ratio 1.85:1.168 cases(75.68%)came from rural,rural urban ratio 1.64:1.About 79 cases(35.59%)of purulent meningitis were preceded with respiratory infection(16.67%),gastroenteritis(9.91%).We found only 4.5%cases didn’t use antibiotics before admission.2.Clinical manifestations:fever in 218 cases(98.2%),atrophy 161 cases(72.52%),alteration of consciousness in 66 cases 29.7%,coma in 23 cases(10.36%),poor feeding 98 cases(44.14%),irritability in 46 cases 20.72%,convulsions in 109 cases(49.10%),headache in 28 cases(12.61%),vomiting in 102 cases(45.95%),frontal uplift in 69 cases(31.08%),91 cases(40.99%)had kernig sign of meningeal irritation and 70 cases(31.53%)had Babinski sign.3.Cerebrospinal fluid and routine blood tests:The lowest CSF white cells count was 4×106/L,the highest value is 47400×106/L,>500×106/L is 123 cases(55.41%);CSF sugar was the lowest 0.00 mmol/L,CSF glucose<1.5 mmol/L was found in 60 cases(27.03%),glucose 1.5-2.8 mmol/L in 79 cases(35.59%);The highest value of CSF protein was 19.76 g/L,and 103 cases(46.40%)had protein>1 g/L.WBC with an average of(15.78±8.88)×109/L,and<4×109/L in 11 patients(4.95).%),12-20 ×109/L were 76 patients(34.23%),>20×109/L were 61 patients(27.48%),mainly neutrophils,the average(10.12 ± 8.09)× 109/L.4.Cerebrospinal fluid culture and blood culture:150 cases(67.57%)of CSF culture was performed,63 cases(42.00%)were positive for etiological test,in which 17 cases were Streptococcus pneumoniae.Blood culture was done on 117 cases(52.70%).We found positive results in 27 cases(23.08%),of which 9 cases of Streptococcus pneumoniae were leading etiology.5.Complications:99 cases(44.59%)had subdural effusion,32 cases(14.41%)had hydrocephalus,17 cases(7.66%)had brain softening,and 10 cases(4.50%)had cerebral hemorrhage and 8 cases(3.60%)had epilepsy6.Risk factors:According to Glasgow clinical outcome scores;138 cases(62.16%)with good prognosis,84 cases(37.84%)with poor prognosis,including 2 deaths(0.90%);Univariate analysis revealed that:apathetic,coma,convulsions,neck rigidity,pupils sluggish reaction to light or absence of pupillary reflex,abnormal muscle tension,abnormal muscle strength,cerebrospinal fluid glucose ≤1.5mmol/L,cerebrospinal fluid protein>1.0g/L,cranial MRI Twelve factors such as CT positive,hemoglobin,and complications were statistically significant with the poor-prognosis(P<0.05).Through Multivariate logistic regression analysis we found coma,cerebrospinal fluid glucose ≤1.5 mmol/L,and complications were important risk factors for adverse prognosis of purulent meningitis(P<0.05).ConclusionPurulent meningitis occurs most often in infants and young children,and is more common within 1 year of age.Male:female is 1.85:1,more cases came from rural than urban.Streptococcus pneumoniae is predominant pathogen causing purulent meningitis.Clinical manifestations are diverse,such as fever,apathy,and headache,vomiting,convulsions and neck resistance,among which fever is the commonest feature.On 59.46%children with complications,the most common complication was subdural effusion.Poor prognostic factors of childhood purulent meningitis are:coma,cerebrospinal fluid sugar ≤1.5mmol/L and complications.Early effective evaluation and treatment for children with poor prognosis are expected to improve the prognosis of the children.