MENINGITIS IN 154 PATIENTS IN A GERMAN PEDIATRIC HOSPITAL - CLINICAL AND EPIDEMIOLOGIC OBSERVATIONS

In a retrospective study, the histories of the non-neonates treated for primary meningitis in the Pediatric Department of Mainz University Hospital between 1986 and 1989 were analyzed with regard to etiological, diagnostic, clinical and epidemiological criteria. In the period studied there were 37 cases of infectious meningitis (11 Neisseria meningitidis (29.7%), 7 H. influenzae (18.9%), 3 S. pneumoniae (8.1%), 16 other (43.2%)), and 117 cases of acute aseptic meningitis syndrome (12 mumps virus (10.3%), 3 Borrelia burgdorferi (7.7%), 3 FSME (2.6%), 2 herpes simplex virus, 91 other (77.8%)). Sixty-six percent of the patients were male. Of the infants with infectious meningitis, 68% were under 5 years old. In contrast, 69% of the children with noninfectious meningitis were aged 5 or older. While 70% of the infectious meningitis cases occurred in fall and winter, 64% of the cases of acute aseptic meningitis syndrome occurred in spring and summer. In differential diagnosis between infectious and acute aseptic meningitis syndrome maximal sensitivity was a CRP value exceeding 0.5 mg/dl, a CSF lactate value of over 3 mmol/l and a CSF cell count of over 2000/3 cells. In none of the cases did a second or third lumbar puncture furnish information additional to that which could have been deduced from physical examination and course of temperature. A second lumbar puncture failed to produce unexpected results, or have consequences for therapy, in any of the 14 cases with noninfectious meningitis. Of 37 infants with infectious disease, one (2.7%) died from the sequelae of pneumococcal meningitis. Recovery was partial in 8 (22.2%) of the 36 surviving infants. The risk factors in these cases were age less than one year (P < 0.074) and seizure prior to hospitalization (P < 0.048). Of 117 infants with aseptic meningitis, one died of herpes simplex virus meningitis (0.9%). There were no cases of partial recovery. While infectious meningitis is rare, the mortality and partial recovery rates continue to be relatively high, despite modern diagnostic and therapeutic modalities.