Clinical analysis of 26 children with recurrent bacterial meningitis

Objective: to explore clinical characteristics of children with recurrent bacterial meningitis (RBM). Methods: The clinical data of children with RBM between 2012 and 2018 were analyzed retrospectively. Results: 26 cases (M/F=20/6) were recruited, with recurrent median age of 4.5 months. The common symptoms included fever, followed by vomiting, headache, and convulsions; 21 cases had abnormal MRI, 6 with subdural effusion; BAEP was abnormal in 13 cases, with extremely severe in 4. There were 58 episodes of RBM, including 21 cases with 2, 4 with 3 and 1 with 4. There were 13 cases with an interval of less 3 weeks, whereas 13 more than 3 weeks. 35 pathogenic bacteria were identified, including 18 with streptococcus pneumonia, 13 with E. coli. There were 6 cases of cerebrospinal fluid rhinorrhea, 1 with ear leakage, and 1 with X-linked agammaglobulin deficiency. The sequelae included deafness (n=3), epilepsy (n=2), language disorder (n=2), motor disorder (n=2) and intellectual disability (n=1). Compared with E. coli group and other etiological group, the patients in the Streptococcus pneumoniae group had an older recurrence age, higher anatomical defects incidence, and longer recurrence interval. The antibacterial course after recurrence was significantly prolonged in the E. coli group;theirs the protein content of CSF at recurrent discharge was significantly lower than that at the first discharge.

Conclusion: E. coli infection is common in infant RMB patients and extend antibacterial treatment course may need.in the case of older children, be highly vigilant against anatomical defects or immune defects, especially when Streptococcus pneumoniae infection.
Keywords: Bacterial Meningitis; Recurrent; Children; Clinical features