Infantile meningitis in England and Wales: a two year study

Article Abstract:

Infantile meningitis, or inflammation of the membranes surrounding the brain and spinal cord in infants, is associated with a high death rate. The incidence (number of new cases) of meningitis among children less than one year of age in England and Wales was assessed from 1985 to 1987. There were a total of 2,123 cases of meningitis in children less than one year of age, producing an incidence of 1.6 cases per 1,000 infants. The incidence of meningitis increased from 0.32 cases per 1,000 infants during the neonatal period (first 4 weeks of life) to 1.22 cases per 1,000 infants during the postneonatal stage (after the first 4 weeks of life). The incidence of this infection was slightly greater in male than female infants, and death occurred in 19.8 percent of the neonates and 5.4 percent of the postneonatal infants. In 50 percent of cases, meningitis was not listed as the cause of death. Most cases of neonatal meningitis resulted from infection with group B beta hemolytic streptococci, Escherichia coli, and Listeria monocytogenes, whereas postneonatal meningitis was commonly caused by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. N. meningitidis was the most common cause of meningitis in infants aged two to six months, whereas H. influenzae commonly caused meningitis among infants aged 7 to 12 months. The death rate due to meningitis was 25 percent in patients infected with group B beta hemolytic streptococci and 32 percent in patients infected with gram negative enteric rods. Low birth weight increased the risk of meningitis, and death was more likely to occur in infants who were in coma when they were admitted to the hospital. Meningitis was treated with chloramphenicol or gentamicin combined with a penicillin or a cephalosporin. Of 49 infants who suffered a relapse (the disease recurred), 3 died. Eighteen infants with increased pressure within the brain coned when the pressure was decreased during lumbar puncture; four of these infants died. (Coning means that the lower region of the brain, known as the brain stem, slips through an opening in the skull, known as the foramen magnum.) The death rate was higher among steroid-treated infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Statistics, Demographic aspects, Meninges

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Antibiotic treatment of suspected neonatal meningitis

Article Abstract:

Neonatal meningitis is the inflammation of the meninges, membranes covering the brain and spinal cord, in the newborn. This disease is associated with a death rate of between 20 and 50 percent, and 50 percent of survivors develop major complications. The incidence of neonatal meningitis is rare and occurs in 0.4 to 1 per 1,000 births. This disease is caused by infections with group B streptococcus, Escherichia coli, Listeria monocytogenes, and Staphylococcus epidermis. The antibiotics used to treat this infection include cefotaxime, penicillin, and gentamicin. Chloramphenicol is not recommended, because it is not very effective and may cause drug resistance in the bacteria. This drug does not kill anaerobic gram-negative bacilli and can interfere with the ability of gentamicin to kill bacteria. In addition, the metabolic pathway for chloramphenicol is not completely developed in the newborn. Pseudomonas infections are usually treated with ceftazidime, and gentamicin is used to treat cases associated with septicemia, or infection of the blood. If the cerebral ventricles (cavities of the brain) are enlarged, antibiotics should be given directly into the ventricles using a device called a Rickham reservoir, which is surgically implanted. If the ventricles are normal, a sample of the fluid contained within the ventricles is analyzed to determine the presence of inflammation. Antibiotic therapy should be continued for three weeks after elimination of bacteria from the cerebrospinal fluid, which surrounds the brain and spinal cord. The size of the ventricles, number of white blood cells and platelets (cells involved in clotting), and levels of C-reactive protein, an indicator of disease progression, should be monitored. Meningitis caused by gram-negative bacteria is associated with a death rate of 20 percent and complications affect 38 percent of patients. The various types of microorganisms that may cause meningitis are discussed further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Antibiotics, Pediatric diseases, Drug therapy

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Congenital parvovirus infection

Article Abstract:

Parvoviruses are viruses that infect animals, but which can cause disease in humans as well. In adults, parvovirus B19 can cause a fever and suppress the synthesis of blood cells. Recent studies have reported complications associated with congenital parvovirus infection (occurring in pregnancy) and effects on blood cells in an infected infant. This article describes the effects of a parvovirus B19 infection which occurred in utero. A boy was born at term after a normal pregnancy, and there were no birth complications. He was in good health and the birth weight was 5.7 pounds. Three hours after birth, a petechial rash (small, purplish, hemorrhagic spots) was observed on the trunk, limbs, palate, and over bony prominences. Blood tests showed that there were low levels of platelets, blood cells required for normal clotting. Tests for clotting and bacterial infection were normal. The infant gradually improved over the next week. Another blood test indicated incompatibility, with the mother having antibodies that reacted with the infant's platelets. In addition, both mother and newborn had antibodies which were reactive against parvovirus B19, and the newborn had detectable levels of viral DNA (genetic material). DNA levels decreased as antiviral antibody levels rose. The infant recovered fully. This report confirms the occurrence of intrauterine parvovirus infections, and is the first to report thrombocytopenic purpura (hemorrhagic disorder associated with low platelet levels) and platelet incompatibility in association with the infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Thrombocytopenic purpura, Parvovirus infections

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