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Risk Factors in Children Older Than 5 Years With Pneumococcal Meningitis: Data From a National Network

Hénaff, Fanny MD*; Levy, Corinne MD†‡; Cohen, Robert MD, PhD†‡§; Picard, Capucine MD, PhD¶‖**; Varon, Emmanuelle MD, PhD††; Gras Le Guen, Christèle MD, PhD*‡‡; Launay, Elise MD, PhD‡‡; for the French Group of Pediatric Infectious Diseases (GPIP)

Pediatric Infectious Disease Journal: May 2017 - Volume 36 - Issue 5 - p 457–461
doi: 10.1097/INF.0000000000001470
Original Studies

Background: The occurrence of meningitis in children >5 years old may be associated with specific predisposing factors that can be anatomic, such as cerebrospinal fluid fistula or breach, or related to genetic susceptibility or N inborn or acquired immunologic defect. This study aimed to assess the anatomical and immunologic risk factors in children >5 years old with pneumococcal meningitis and prospectively enrolled in the French national meningitis network.

Methods: We analyzed all data for children who were 5–15 years old with a diagnosis of pneumococcal meningitis between 2001 and 2013. We describe the frequency and typology of the anatomic or immunologic risk factors, the clinical features and the pneumococcal serotypes.

Results: Among the 316 patients with pneumococcal meningitis, the mortality rate was 9.5% and 23.1% of cases presented complications (abscess, coma, hemodynamic failure, thrombophlebitis cerebral or deafness). In total, 108 children (34%) showed risk factors, the most frequent being anatomic: 70 cases (22.8%) were related to a cerebrospinal fluid breach or fistula and 55 (17.9%) to immunodeficiency, primary or acquired. Serotype data were available for 207 pneumococcal isolates (65.5%). The most frequent serotypes were as follows: 3, 18C, 19A and 19F between 2001 and 2009 and 19F, 3, 19A, 12F, 22F, 17F and 24F after 2009.

Conclusions: We describe the largest cohort of children >5 years old with pneumococcal meningitis. One third of the children had risk factors justifying a complete immunologic and radiologic work-up.

From the *Urgences pédiatriques, CHU Nantes, Hôpital Mère-Enfant, 44093 Nantes, France; ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, 94100 Saint-Maur des Fossés, France; Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; §Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Laboratoire de génétique humaine des maladies infectieuses, institut national de la santé et de la recherche médicale, UMR1163, Institut IMAGINE, 75015 Paris, France; Faculté de médecine de Necker, Université Paris V René-Descartes, 75015 Paris, France; **Centre d’études des déficits immunitaires (CEDI), AP-HP, hôpital Necker-Enfants-Malades, 75015 Paris, France; ††Centre National de Référence des Pneumocoques, AP-HP, HEGP (Hôpital Européen Georges Pompidou), Université Paris V, 75006 Paris, France; and ‡‡Pédiatrie générale, CHU Nantes, Hôpital Mère-Enfant, 44093 Nantes, France.

Accepted for publication September 16, 2016.

The authors have no conflicts of interest to disclose.

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Address for correspondence: Fanny Hénaff, MD, Urgences pédiatriques, CHU Nantes, Hôpital Mère-Enfant, 7 quai moncousu, 44093 Nantes, France. E-mail: fanny.henaff@gmail.com.

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