GRAM-NEGATIVE BACILLARY MENINGITIS IN INFANTS AND CHILDREN IN DEVELOPING-COUNTRIES

Gram negative bacillary meningitis (GNBM) in postneonatal infants and children is two to three times more common in developed compared to de veloping countries. Other major differences are in the pattern of path ogens (mainly Klebsiella spp and Salmonella spp in developing versus E . coli in developed countries) and associated conditions (diarrhoeal d iseases and malnutrition in developing versus neurosurgical and urinar y tract abnormalities in developed countries). 12 (11.5%) of 104 cases of bacterial meningitis were due to GNB, including Klebsiella spp sev en, E. coli, two and untyped Coliform spp, three; the age range of pat ients with GNBM was 3-24 months. Among seven completely evaluable pati ents, six presented after seven days of illness, five convulsed on or before admission, and six had accompanying respiratory or gastro-enter itic illnesses but none was severely malnourished or had associated ne urosurgical or urinary tract abnormalities. Three patients died, three were discharged with sequelae and one without sequelae. The only sign ificant difference between patients with GNBM and those with meningiti s due to ''usual'' pathogens was the greater tendency to delayed prese ntation among the former (6/7 patients with GNBM versus 11/36 ''usual' ' pathogens; p = 0.011); this was also the only striking difference in presentation when compared with patients from developed countries. Th e need for further studies, preferably multicentred, and for a revisio n of the traditional combination of gentamicin and ampicillin or chlor amphenicol and ampicillin for the treatment of GNBM in developing coun tries is discussed.