Salmonella meningitis in children in Libreville, Gabon. A retrospective study of nine cases.

Background. - Salmonella meningitis is a rare entity even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult. Patients and methods. - The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied Diagnosis was established by a positive culture of cerebrospinal fluid. Results. - Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from law socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (sir cases), diarrhea (four cases), nuchal rigidity (four casesj, conclusions (three cases) and bulging fontanel (three cases). Five children (55.5% were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in thr ee divided doses) was given to seven patients. The duration of therapy was at least 3 weeks inform patients. There were five deaths at ages ranging from I to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels. Conclusion. - The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.