Acute purulent meningitis in Alaska natives: epidemiology, diagnosis and prognosis.

During the period 1957-1964, 69 cases of purulent meningitis were treated at the U.S. Public Health Service Hospital in Bethel, Alaska, a 65-bed facility serving about 10,000 Eskimos and Indians in the remote Yukon-Kuskokwim Delta area. Nearly two-thirds of the patients were infants, among whom the case fatality rate was 37.2%, compared with the overall fatality rate of 30.4%. In 52% of the cases no causative organism could be demonstrated on smear or culture. Of the bacteriologically positive cases, one-third were due to pneumococci and one-third to meningococci. Prognosis was not affected by previous treatment or recovery of the organism. Since 1957, an annual average of one out of 74 infants in the area has had purulent meningitis; one out of 200 has died of the disease. Chronic otitis media, poor nutrition, a high incidence of respiratory disease and the relative inaccessibility of medical care are significant factors.