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Byline: M. Karim (1), N. Islam (2) Keywords: Key WordsSalmonella meningitis; Presentation; Treatment. Abstract: Salmonella meningitis is an unusual complication of Salmonella sepsis and occurs almost exclusively in infants and young children. One case of Salmonella meningitis and two cases of cerebrospinal fluid (CSF) pleocytosis in adult patients with Salmonella bacteremia were studied and the literature was reviewed. On a retrospective review of the charts of 100 sequential patients with Salmonella typhi and S. paratyphi-positive blood cultures, we found one patient with fulminant Salmonella meningitis and two others with CSF pleocytosis. All three patients survived. The patient with Salmonella meningitis had significant residual neurologic sequela. Salmonella encephalopathy occurred in six other patients who presented with headache and were confused or drowsy. Cases of meningitis in adults do occur and are associated with a high morbidity and mortality. Newer cephalosporin antibiotics may be the therapy of choice in these infections. Author Affiliation: (1) St. Joseph's Hospital Health Center, 301 Prospect Avenue, Syracuse, NY 13203, USA Phone (+1/315) 448-6253, Fax: -6264, e-mail: michele.karim@sjhsyr.org, US (2) Dept. of Medicine, Aga Khan University Hospital, Karachi, Pakistan, PK Article note: Received: July 3, 2001 * Revision accepted: December 27, 2001

Children with bacterial meningitis who are not diagnosed during their initial visit to the physician may not suffer lasting harm from the diagnostic delay. Researchers studied 325 children with meningitis who were between three months and 15 years of age. Thirty-seven patients had been examined by a physician and sent home two to four days before meningitis was diagnosed. Forty-seven children were examined and released one day before meningitis diagnosis and 241 patients were diagnosed during their initial physician visit. At hospital admission, patients sent home two to four days before diagnosis were more likely to have respiratory symptoms, middle ear infections, fewer seizures and less impaired consciousness than children who were diagnosed immediately. At discharge or six-month follow-up the rates of hearing impairment, neurologic abnormalities, and death among children in the three groups were similar., Objective. - To assess the effect of a recent previous visit to a physician on the outcome of meningitis in children. Design. - Evaluation of data from children examined by a physician and sent home, either the previous day or 2 to 4 days before meningitis was diagnosed, and children whose meningitis was diagnosed at once. The patients were examined daily during hospitalization, neurologic examinations were repeated at 2 weeks and 3 and 6 months after discharge, and hearing was assessed 2 or more months after discharge. Setting. - Eighteen pediatric hospitals in Finland from 1984 through 1991. Population. - A total of 325 children aged 3 months to 15 years with bacterial meningitis. Main Outcome Measures. - Clinical and laboratory findings on admission, recovery during hospitalization, mortality, and neurologic abnormalities at 6 months of follow-up. Results. - In 74% of the patients, meningitis was diagnosed at once, 14% had visited a physician on the previous day, and 11 % had seen a physician 2 to 4 days before diagnosis. The group seen 2 to 4 days earlier had a better level of consciousness, less frequent seizures, and more respiratory symptoms and otitis media than the other groups. The cerebrospinal fluid leukocyte count, white blood cell count, and erythrocyte sedimentation rate were highest and the cerebrospinal fluid glucose concentration was lowest in the children who had visited a physician 2 to 4 days earlier, although they also had lower cerebrospinal fluid protein and urine sodium and potassium levels. This group had the most rapid return to normal consciousness. There was no difference in the incidence of hearing impairment or neurologic sequelae. Even the mortality was virtually the same in the three groups: 4%, 4%, and 3% in the "same day," "previous day," and "2 to 4 days earlier" groups, respectively. Conclusions. - Children who had visited a physician the previous day or 2 to 4 days before meningitis was diagnosed did not exhibit an increased frequency of hearing impairment, other neurologic abnormalities, or overall adverse outcome compared with children whose meningitis was diagnosed at once.

Long-term morbidity rates of neonatal meningitis (21%-56%) have remained high in the last 2 decades, during which time mortality rates have declined.[1-8] The severity of illness and outcomes of infectious [...], Objective. To build predictive models of severe adverse outcome at various times in the course of neonatal bacterial meningitis. Study Design. Retrospective cohort study with follow-up to a minimum age of 1 year of term and near-term infants, admitted between 1979 and 1998 to a regional tertiary care center. Predictors of adverse outcome detectable at 1 year of age (death or moderate or severe neurosensory impairment) were identified by univariate analysis. Independent predictors of adverse outcome were identified by multivariate analysis. Predictive tree models were constructed at 12, 24, 48, and 96 hours after admission and at discharge. Results. Of 101 infants admitted with definitive bacterial meningitis, 13 died and 17 had moderate or severe disability at 1 year of age. Outcomes are known for all patients, to 1 year of age. Twelve hours after admission the important predictors of adverse outcome were presence of seizures, presence of coma, use of inotropes, and leukopenia (sensitivity: 68%; specificity: 100%). At 96 hours the predictors were seizure duration of [is greater than] 72 hours, presence of coma, use of inotropes, and leukopenia (sensitivity: 88%; specificity: 99%). Conclusions. Most infants at risk for adverse outcome can be identified within 12 hours of admission. Duration of seizures for [is greater than] 72 hours, presence of coma, use of inotropes, and leukopenia were the most important predictors of adverse outcome. Although these models have good predictive accuracy, they need to be validated in a contemporary cohort in large multicenter studies. Pediatrics 2000;106:477-482; bacterial meningitis, neonate, prognostic model. ABBREVIATIONS. CSF, cerebrospinal fluid; GA, gestational age; SD, standard deviation.