The infectious diseases of the central nervous system in children continue to retain the status of a current clinical and scientific problem. The leading place in the structure of the central nervous system nosology of infectious lesions occupies bacterial purulent meningitis (BPMs), characterised by severe, high mortality rate and the risk of the formation of neurological deficiency in the residual period of the disease. BPMs occupy the tenth place in the structure of mortality rate from infectious diseases.
The aim To investigate the clinical and epidemiological features of bacterial purulent meningitis in children registered in the Krasnoyarsk Territory.
We have analysed the etiologic and age structure, the degree of the severity, the course and outcome of the disease in 142 children aged 0 to 14 years old who were hospitalised in the infectious hospital of Krasnoyarsk in the period 2011–2016. We used the methods of laboratory diagnostics (PCR, reaction of latex agglutination, bacterial inoculation of cerebrospinal fluid and blood for aetiology evaluation) that allowed deciphering the aetiology in 59.8% of patients observed. Based on the laboratory tests results, 38% (54 patients) were diagnosed with meningococcal meningitis (MM), while in 57.4% of cases the disease was associated with meningococcemia. In 12.9% (11 patients) the pneumococcal aetiology of meningitis and in 9.4% (8 patients) the hemophilic aetiology of meningitis was confirmed. The babies of the first month of life (18.58%) had demonstrated the BPME clinical picture; in 33.3% of cases Streptococcus group B was a leading causative factor. The aetiology of BPMs has not been established in 40.2% (57 patients). The largest part of the patients with BPMs was represented by the children aged from 0 to 3 years – 79.6% (113 patients). BPMs usually developed in children with altered premorbid background: hypoxic-ischaemic injury of the central nervous system (55.8%), frequent SARS in anamnesis (10.6%), and congenital malformations (4.2%). It is known that the BPM can be both primary and secondary due to the generalisation of the primary site of infection. Thus, the analysis of the cases revealed that in 37.6% (53 patients) the development of meningitis was preceded by acute inflammatory diseases of the upper respiratory tract, otitis, and sinusitis. Post-traumatic injury of the CNS occurred in 5.6% of cases (8 patients). Depending on the severity of general infections, general cerebral and meningeal symptoms, the character of the CSF and peripheral blood changes, severe BPMs developed in 71.2% of the patients, while 28.8% had demonstrated moderate BPMs. The attention is drawn to a large percentage of complications that developed in the acute period of BPMs, with prevailing septic shock (27.5%) with the development of Waterhouse-Friderichsen syndrome (3.5%), oedema of the brain (37.3%), and impaired consciousness (23.9%). The lethal outcome occurred in 9.8% of cases (14 patients). In 31% of patients, severe residual effects occurred: hypertensive hydrocephalus syndrome (21%), paresis and paralysis (4.7%),- convulsions (1.56%), and strabismus (14%).
Thus, the analysis shows that BMPs are characterised by a predominance of severe, complicated forms of the disease, a possible development of lethal outcome, which in turn requires searching for new highly sensitive markers of severity assessment and prognosis.
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