Lm. Sommers et Ds. Hawkins, Meningitis in pediatric cancer patients: a review of forty cases from a single institution, PEDIAT INF, 18(10), 1999, pp. 902-907
Background. Although the clinical features of bacterial meningitis in adult
cancer patients and in healthy children have been described, no previous l
arge series has described the clinical features of meningitis in pediatric
cancer patients. We performed a retrospective review of bacterial or fungal
meningitis in pediatric cancer patients to determine its clinical presenta
tion, microbiology and outcome.
Method. We reviewed the medical records of all patients younger than 18 yea
rs old with a diagnoses of any malignancy and bacterial or fungal meningiti
s at Children's Hospital and Regional Medical Center in Seattle, WA, hom Ja
nuary, 1981, to June, 1998,
Results. During the study period there were 40 cases of bacterial or fungal
meningitis in 36 pediatric cancer patients. Most patients (65%) had recent
neurosurgery, a central nervous system device or cerebrospinal fluid leak,
Neutropenia was present in 30% of patients. Fever and altered mental statu
s were the most consistent signs at presentation. In addition at least one
additional symptom or sign of meningitis (headache, neck pain or rigidity,
seizures or photophobia) was present in 77% of cases. Staphylococcus aureus
and Streptococcus pneumoniae were the most common microbiologic isolates.
The five patients with fatal outcome were neutropenic, Neutropenia and seiz
ures within 2 days of presentation were associated with long neurologic seq
uelae,
Conclusions, Meningitis in pediatric cancer patients was associated with si
gnificant morbidity and mortality. Pediatric cancer patients with meningiti
s had clinical features and microbiology distinctly different from those of
adult cancer patients and normal children with meningitis.