Pediatric Bacterial Meningitis in the Philippines
By Cecilia C Maramba-Untalan, MD

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Slide 1 - Title Slide Pediatric Bacterial Meningitis in the Philippines By Cecilia C Maramba-Untalan, MD

Slide 2 Bacterial meningitis continues to be among the top ten killers of children less than four years old in the Philippines. Pathogens isolated from patients with this disease as well as their susceptibility patterns are different from those isolated in western countries. Thus their recommendations for therapy are not appropriate for use in this setting. The Philippine Society of Microbiology and Infectious Diseases convened a panel of experts- Pediatric Infectious Disease Specialists, Pediatric Neurologists and other allied medical professionals. They were tasked to provide clinicians a rational approach in the management of bacterial meningitis which is evidence-based, taking into consideration appropriate local data. Thus this lecture summarizes many of the important issues tackled by this Task Force

Slide 3 A delay in treatment leads to higher morbidity and mortality, thus early recognition of the disease is necessary. Signs and symptoms of bacterial meningitis is variable and depends on the age of the patient and the duration of illness before treatment. Neonates and young infants may only have subtle manifestations. These are difficult to distinguish from a coexisting septicemia.

Slide 4 Signs and symptoms include non-specific signs, and signs of meningeal inflammation. Signs and symptoms of increased intracranial pressure and focal neurologic signs may already be late indicators of disease. Depending on the age of the patient, these manifestations may differ. No one clinical sign is pathognomonic of meningitis. Bacterial meningitis should be suspected in a child with any 2 or more non-specific signs or symptoms or any of the specific neurologic signs and symptoms.

Slide 5 In any case suspected of meningitis based on the clinical signs, a lumbar puncture is essential. Sometimes parents are afraid of the procedure and fear it is harmful to the child. It should be emphasized to them that treatment is highly dependent on CSF results. A lumbar puncture may be postponed or withheld in the following situations: presence of significant cardiac or respiratory distress and shock, sign of increased intracranial pressure, infection in the area that the spinal needle will traverse to obtain CSF, and hematologic problems such as thrombocytopenia and coagulation defects.

Slide 6 The following are the CSF findings that will make you confirm the diagnosis of meningitis: the CSF pressure may be elevated, there is leukocytosis with predominance of PMNs, the glucose is low, the CSF blood to glucose ratio is <0.40, and the protein is elevated. The stained smears of CSF may be (+) for bacteria. Culture of CSF should be done whenever it is available, but a negative culture does not rule out meningitis.

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