0
April 1990, Vol 144, No. 4 >
Article | April 1990

Bacterial Meningitis in Older Children FREE

William A. Bonadio, MD; Mark Mannenbach, MD; Robert Krippendorf, MD
[+] Author Affiliations

Accepted for publication September 11, 1989.

Reprint requests to 1240 Pioneer Trail, Waukesha, WI53186 (Dr Bonadio).


Am J Dis Child. 1990;144(4):463-465. doi:10.1001/archpedi.1990.02150280085016.
Text Size: A A A
Published online
Article
References
Comments

• A review was performed of 25 cases of bacterial meningitis in previously healthy children aged 6 years or older during a 10-year period. The rate of infection in this age group relative to all cases of pediatric bacterial meningitis was 4%. Pathogens included Haemophilus influenzae type b in 10 cases (40%), Neisseria meningitidis in 9 cases (36%), and Streptococcus pneumoniae in 6 cases (24%). Physical findings revealed 21 patients (84%) with some degree of altered consciousness and 25 patients (100%) with nuchal rigidity. In all instances, the cerebrospinal fluid exhibited pleocytosis with a predominance of polymorphonuclear leukocytes. Eleven patients (44%) were afebrile on presentation. Of 22 surviving patients, 10 (45%) were afebrile without subsequent fever after administration of the initial dose of antibiotics, in 5 (23%) fever resolved within 24 hours, and in 6 (27%) fever resolved within 48 hours of treatment; there was no instance of prolonged or secondary fever noted. Death occurred in 3 cases (12%). Bacterial meningitis is uncommon in older children. As compared with younger children, older children with bacterial meningitis commonly present without fever and tend to have their fever resolve shortly after effective antibiotic therapy is initiated without manifesting prolonged or secondary fever patterns. Haemophilus influenzae type b is a common cause of bacterial meningitis in children aged 6 years or older; empirical antibiotic therapy in this clinical situation should include treatment of this pathogen.

(AJDC. 1990;144:463-465)

REFERENCES

1 +
Krieg AF.  Cerebrospinal fluid and other body fluids . In: Henry JB, ed. Clinical Diagnosis and Management by Laboratory Methods . 16th ed. Philadelphia, Pa: WB Saunders Co; 1981;:635-657.
2 +
Schlech WF, Ward JI, Band JD, et al.  Bacterial meningitis in the United States, 1978-1981: the National Bacterial Meningitis Surveillance Study . JAMA . 1985;;253:1749-1754.
3 +
Swartz MN, Dodge PR.  Bacterial meningitis: a review of selected aspects, I: general clinical features, special problems and unusual meningeal reactions mimicking bacterial meningitis . N Engl J Med . 1965;;272:725-731.
4 +
Del Rio M, Chrane D, Shelton S, McCracken GH, Nelson JD.  Ceftriaxone versus ampicillin and chloramphenicol for treatment of bacterial meningitis in children . Lancet . 1983;;1:1241-1244.
5 +
Feigin RD.  Bacterial meningitis beyond the newborn period . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1981;:293-304.
6 +
Geiseler PJ, Nelson KE.  Bacterial meningitis without signs of meningeal irritation . South Med J . 1982;;75:448-450.
7 +
Klein JO, Feigin RD, McCracken GH.  Report of the task force on diagnosis and management of meningitis . Pediatrics . 1986;;78( (suppl) ):959-982.
8 +
Stutman HR, Marks MI.  Bacterial meningitis in children: diagnosis and treatment . Clin Pediatr . 1987;;26:431-438.
9 +
Rutman DL, Wald ER.  Fever in Haemophilus influenzae type b meningitis . Clin Pediatr . 1981;;20:192-195.
10 +
Balagtas RC, Levin S, Nelson SE, Gotoff S.  Secondary and prolonged fevers in bacterial meningitis . J Pediatr . 1970;;77:957-964.
11 +
Lin TY, Nelson JD, McCracken GH.  Fever during treatment for bacterial meningitis . Pediatr Infect Dis . 1984;;3:319-322.
12 +
Dodge PR, Swartz MN.  Bacterial meningitis: a review of selected aspects, II: special neurologic problems, postmeningitic complications and clinicopathologic correlations . N Engl J Med . 1965;;272:954-960.
13 +
Lindberg J, Rosenhall U, Nylen O, Ringner A.  Long-term outcome of Haemophilus influenzae meningitis related to antibiotic treatment . Pediatrics . 1977;;60:1-6.
14 +
Dodge PR.  Sequelae of bacterial meningitis . Pediatr Infect Dis . 1986;;5:618-620.
15 +
Kaplan SL, Feigin RD.  Clinical presentations, prognostic factors and diagnosis of bacterial meningitis . In: Sande MA, Smith AL, Root RK, eds. Bacterial Meningitis . New York, NY: Churchill Livingstone Inc; 1985;:80-85.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Krieg AF.  Cerebrospinal fluid and other body fluids . In: Henry JB, ed. Clinical Diagnosis and Management by Laboratory Methods . 16th ed. Philadelphia, Pa: WB Saunders Co; 1981;:635-657.
2 +
Schlech WF, Ward JI, Band JD, et al.  Bacterial meningitis in the United States, 1978-1981: the National Bacterial Meningitis Surveillance Study . JAMA . 1985;;253:1749-1754.
3 +
Swartz MN, Dodge PR.  Bacterial meningitis: a review of selected aspects, I: general clinical features, special problems and unusual meningeal reactions mimicking bacterial meningitis . N Engl J Med . 1965;;272:725-731.
4 +
Del Rio M, Chrane D, Shelton S, McCracken GH, Nelson JD.  Ceftriaxone versus ampicillin and chloramphenicol for treatment of bacterial meningitis in children . Lancet . 1983;;1:1241-1244.
5 +
Feigin RD.  Bacterial meningitis beyond the newborn period . In: Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1981;:293-304.
6 +
Geiseler PJ, Nelson KE.  Bacterial meningitis without signs of meningeal irritation . South Med J . 1982;;75:448-450.
7 +
Klein JO, Feigin RD, McCracken GH.  Report of the task force on diagnosis and management of meningitis . Pediatrics . 1986;;78( (suppl) ):959-982.
8 +
Stutman HR, Marks MI.  Bacterial meningitis in children: diagnosis and treatment . Clin Pediatr . 1987;;26:431-438.
9 +
Rutman DL, Wald ER.  Fever in Haemophilus influenzae type b meningitis . Clin Pediatr . 1981;;20:192-195.
10 +
Balagtas RC, Levin S, Nelson SE, Gotoff S.  Secondary and prolonged fevers in bacterial meningitis . J Pediatr . 1970;;77:957-964.
11 +
Lin TY, Nelson JD, McCracken GH.  Fever during treatment for bacterial meningitis . Pediatr Infect Dis . 1984;;3:319-322.
12 +
Dodge PR, Swartz MN.  Bacterial meningitis: a review of selected aspects, II: special neurologic problems, postmeningitic complications and clinicopathologic correlations . N Engl J Med . 1965;;272:954-960.
13 +
Lindberg J, Rosenhall U, Nylen O, Ringner A.  Long-term outcome of Haemophilus influenzae meningitis related to antibiotic treatment . Pediatrics . 1977;;60:1-6.
14 +
Dodge PR.  Sequelae of bacterial meningitis . Pediatr Infect Dis . 1986;;5:618-620.
15 +
Kaplan SL, Feigin RD.  Clinical presentations, prognostic factors and diagnosis of bacterial meningitis . In: Sande MA, Smith AL, Root RK, eds. Bacterial Meningitis . New York, NY: Churchill Livingstone Inc; 1985;:80-85.

Correspondence

Submit a Letter
CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Clear Answers | Save For Later
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2013 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems