Pneumococcal meningitis in children.

We review the clinical and laboratory features of 79 children with 83 episodes of pneumococcal meningitis over a 26-year period. The onset of illness was often severe, with convulsions occurring in 31% of the patients. The mortality was 10.8% and all deaths occurred in patients younger than 1 year of age; the death rate has dropped from 19% in the 1948 to 1962 era to 3% from 1963 to 1973. The association of pneumonia with meningitis, the presence of hypoglycorrhachia, and an increased CSF protein concentration were associated with a poor prognosis; bacteremia and convulsions were also more common in the fetal cases. Neurologic sequelae including recurrent meningitis, deafness, hydrocephalus, convulsions, and retardation were present in 56% of the patients observed. Findings from EEGs did not correlate well with the clinical picture during the acute or convalescent stage of the illness. Despite accurate diagnosis, prompt therapy, and a decrease in the mortality in the past decade, pneumococcal meningitis in children is still often associated with a serious outcome.