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Stroke in paediatric pneumococcal meningitis: a cross-sectional population-based study
  1. Kate Pryde1,
  2. Woolf T Walker1,2,3,
  3. Clare Hollingsworth4,
  4. Philippa Haywood5,
  5. James Baird6,
  6. Martin Hussey7,
  7. Amanda Freeman8,
  8. Mary Gawne-Cain1,
  9. Bettina Harms9,
  10. Fenella J Kirkham1,3,10,
  11. Saul N Faust1,2,3
  1. 1 Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2 NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3 Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
  4. 4 Department of Paediatrics, Dorchester County Hospital NHS Foundation Trust, Dorchester, UK
  5. 5 Department of Paediatrics, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
  6. 6 Department of Paediatrics, Salisbury NHS Foundation Trust, Salisbury, UK
  7. 7 Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
  8. 8 Department of Paediatrics, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  9. 9 Department of Paediatrics, St Mary's Hospital, Isle of Wight NHS Trust
  10. 10 Neurosciences Unit, UCL Institute of Child Health, London, UK
  1. Correspondence to Professor Fenella Kirkham, Paediatric Neurology, Department of Child Health, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; Fenella.Kirkham{at}ucl.ac.uk

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Before routine infant pneumococcal immunisation and improved access to neuroimaging, around 25% of children with pneumococcal meningitis (PM) suffered ischaemic stroke (IS).1 ,2 In a population-based retrospective audit (UHS ZAUD2053), we investigated the postimmunisation prevalence of stroke/cerebrovascular disease (CVD), and compared features of children with and without IS/CVD.

We included all cases of PM in children <18 years old with a Wessex postcode admitted to our tertiary centre, University Hospital Southampton (UHS) and the eight hospitals in our referral catchment area of Hampshire and Dorset (2001 childhood population approximately 750 000) from April 2007 to March 2009 inclusive. A coauthor collected data from each of the nine laboratories reporting cerebrospinal fluid (CSF) culture to their clinicians and the national database. A neuroradiologist (MG-C) reviewed clinically indicated neuroimaging blinded to outcome. For UHS, we also reviewed all cases with positive pneumococcal blood cultures during the study period. Criteria for PM diagnosis included (1) positive CSF culture or (2) when no CSF was available, positive blood culture or urinary antigen plus either >5 white cells in the CSF and/or signs of meningism and/or focal neurology and/or meningeal enhancement on CT with contrast. Stroke and/or CVD were identified on CT …

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