Yudy Fonseca1, Taty Tshimanga2, Stephen Ray3, Helen Malhotra4, Jean Pongo5, Joseph Bodi Mabiala2, Montfort Bernard Gushu6, Tusekile Phiri6, Bertha Mekiseni Chikaonda6, Davin Ambitapio Musungufu7, Mananu Uchama7, Nicole Fortier O'Brien8. 1. Division of Critical Care Medicine, Department of Pediatrics, University of Maryland, Baltimore, MD, United States. 2. Department of Pediatrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo. 3. Malawi Liverpool Wellcome Trust Clinical Research Programme, Paediatric Registrar & Wellcome Trust Clinical Fellow, Blantyre, Malawi. 4. Department of Behavioral Neuroscience, Northeastern University, Boston, MA, United States. 5. Department of Medicine, Universite des Sciences et des Technologie de Lodja (USTL), Lodja, Democratic Republic of Congo. 6. Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre Malaria Project, Blantyre, Malawi. 7. L'Hopital Generale de Reference de Nyankunde, Nyankunde, Democratic Republic of Congo. 8. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States.
Abstract
Introduction: Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common. Methods: This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month-18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing. Results: Forty-seven patients were analyzed. The majority had Streptococcus pneumoniae (36%) or Neisseria meningitides (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, p = 0.001). Conclusions: Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.
Introduction: Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common. Methods: This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month-18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing. Results: Forty-seven patients were analyzed. The majority had Streptococcus pneumoniae (36%) or Neisseria meningitides (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, p = 0.001). Conclusions: Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.
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