Bacterial meningitis in older children
W. A. Bonadio, M. Mannenbach and R. Krippendorf
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital, Milwaukee.
A review was performed of 25 cases of bacterial meningitis in previously
healthy children aged 6 years or older during a 10-year period. The rate of
infection in this age group relative to all cases of pediatric bacterial
meningitis was 4%. Pathogens included Haemophilus influenzae type b in 10
cases (40%), Neisseria meningitidis in 9 cases (36%), and Streptococcus
pneumoniae in 6 cases (24%). Physical findings revealed 21 patients (84%)
with some degree of altered consciousness and 25 patients (100%) with
nuchal rigidity. In all instances, the cerebrospinal fluid exhibited
pleocytosis with a predominance of polymorphonuclear leukocytes. Eleven
patients (44%) were afebrile on presentation. Of 22 surviving patients, 10
(45%) were afebrile without subsequent fever after administration of the
initial dose of antibiotics, in 5 (23%) fever resolved within 24 hours, and
in 6 (27%) fever resolved within 48 hours of treatment; there was no
instance of prolonged or secondary fever noted. Death occurred in 3 cases
(12%). Bacterial meningitis is uncommon in older children. As compared with
younger children, older children with bacterial meningitis commonly present
without fever and tend to have their fever resolve shortly after effective
antibiotic therapy is initiated without manifesting prolonged or secondary
fever patterns. Haemophilus influenzae type b is a common cause of
bacterial meningitis in children aged 6 years or older; empirical
antibiotic therapy in this clinical situation should include treatment of
this pathogen.
