PNEUMOCOCCAL MENINGITIS IN CHILDREN - PROGNOSTIC INDICATORS AND OUTCOME

We studied the outcome of pneumococcal meningitis in 83 children who w ere admitted to a referral hospital and whose meningitis was diagnosed between 1970 and 1994. The median age of the children was 8 months. T he most frequently isolated capsular serotypes and/or serogroups of St reptococcus pneumoniae were 6, 14, 18, 19, and 23. Twenty-nine childre n (35%) were referred by other hospitals. A mortality rate of 17% (pri mary referrals, 7%; secondary referrals, 35%) was observed. At dischar ge, 25 survivors (36%) had sequelae: hearing loss (greater than or equ al to 30 dB) in 19% and neurological sequelae in 25%. During admission , the presence of coma, respiratory distress, shock, a cerebrospinal f luid (CSF) protein level of greater than or equal to 2.5 g/L, a periph eral white blood cell count of <5 x 10(9)/L, and a serum sodium level of <135 mmol/L were associated with mortality. Sequelae were associate d with the presence of coma and a CSF glucose level of <0.6 mmol/L. We conclude that the mortality rate of pneumococcal meningitis is lower among children than among adults. Children often die of neurological s equelae, while adults frequently die of cardiorespiratory failure due to underlying diseases. For children, coma, respiratory distress, and shock during admission were the clinical findings with the strongest p redictive value for sequelae or death.