The profile of meningitis in a tertiary paediatric hospital in South Africa

Background. Meningitis in children is a major health problem worldwide, leading to high rates of mortality and morbidity. Objectives. To describe the profile of patients treated for meningitis at a leading tertiary paediatric hospital (Red Cross War Memorial Children's Hospital) in South Africa. Methods. This study describes all patients treated for suspected meningitis at our hospital from 2010 to 2012. Data were retrospectively collected from patient folders. Results. A total of 706 patients with meningitis were divided into definite bacterial (n=42), probable bacterial (n=113), partially treated bacterial (n=100), viral (n=412), and tuberculous meningitis (TBM, n=39)) infections. Fever (74.7%), headache (66.4%), vomiting (52.1%) and irritability (34.5%) were common symptoms in all patients; TBM patients presented more often with weight loss, neck stiffness, lethargy and abnormal neurological signs. Symptoms were usually present for 1 - 2 days in viral and bacterial meningitis, and 8 days in TBM. The median duration of hospitalisation was 1 day for viral meningitis, 2 days for all three groups of bacterial meningitis and 22 days for TBM, before referral to primary or secondary hospitals. Conclusion. Patients with meningitis in this study often presented with nonspecific symptoms, making it difficult to clinically differentiate between types of meningitis. TBM patients presented more often with neurological fallout, and had a longer duration of symptoms. Patients often received antibiotics before a lumbar puncture was performed, further compounding the difficulty of diagnosis. Swift, sensitive and specific novel diagnostic tools would aid clinicians in making timeous and accurate diagnoses and treatment decisions.