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.
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.
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.
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.
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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: firstname.lastname@example.org.