H Trotman1, O Olugbuyi, M Barton, D McGregor, S Thomas. 1. Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica. helen.trotmanedwards@uwimona.edu.jm
Abstract
OBJECTIVE: To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS: All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS: Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS: Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.
OBJECTIVE: To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS: All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS: Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS:Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.