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Recurrent Pneumococcal Meningitis in Children

A Multicenter Case–control Study

Darmaun, Laura MD*; Levy, Corinne MD, PhD†,‡,§,¶; Lagrée, Marion MD*,‡; Béchet, Stéphane MSc†,§,¶; Varon, Emmanuelle MD‡,‖; Dessein, Rodrigue MD, PhD**; Cohen, Robert MD†,‡,§,¶,‡‡; Martinot, Alain MD*,‡,††; Dubos, François MD, PhD*,‡,†† for the ACTIV-GPIP Study Group

The Pediatric Infectious Disease Journal: September 2019 - Volume 38 - Issue 9 - p 881–886
doi: 10.1097/INF.0000000000002358
Original Studies

Background: Pneumococcal meningitis (PM) is a serious disease that can rarely recur at a later time after the initial episode.

Methods: A retrospective multicenter case–control study was conducted with data for children 18 years of age or younger obtained from the National Observatory of Bacterial Meningitis in Children between January 2001 and September 2015. Cases were all patients with RPM. Each case was matched with 2 randomized controls with a single PM episode in the year of the first episode of PM in the case and born the same year. Case and control data were compared.

Results: Among the 1634 PM episodes in children 18 years of age or younger, 24 (1.5%) children had RPM. RPM cases were significantly less frequent than single PM cases in winter (27% vs. 48%; P=0.03) and showed significantly less concomitant ear, nose and throat infections when considering the first episode (30% vs. 56%, P = 0.04) and all episodes (28% vs. 56%, P < 0.01). Cerebrospinal fluid leakage was frequent in RPM cases versus controls (83% vs. 10%, P < 0.01), including 25% discovered after the third PM episode. Immune deficiency was absent in cases and present in 15% of controls. Cases and controls did not differ in death rate or neurologic outcome.

Conclusions: RPM is rare in children. Cerebrospinal fluid leakage must be considered.

From the *CHU Lille, Urgences pédiatriques & maladies infectieuses, Lille, France

ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Saint Maur-des-Fossés, France

GPIP, Groupe de Pathologies infectieuses Pédiatriques, Paris, France

§Université Paris Est, IMRB-GRC GEMINI, Créteil, France

Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France

National Reference Center for Pneumococci, Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France

**University of Lille, CHU Lille, Service de Bactériologie

††University of Lille, EA2694: Santé Publique, Épidémiologie & Qualité des Soins, CHU Lille, University Lille, Lille, France

‡‡Unité Court Séjour, Petits nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, France.

Accepted for publication March 14, 2019.

The study was funded by the Pediatric Infectious Diseases Group of the French Pediatrics Society, Association Clinique et Thérapeutique Infantile du Val de Marne and Pfizer. The National Reference Center for Pneumococci was partially funded by the French National Health Agency.

R.C., C.L. and E.V. received grants and personal fees from Pfizer. A.M. has had appointments for consultancy/advice (GSK vaccines, Pfizer) and invitations to European Society for Paediatric Infectious Disease meetings (GSK vaccines, Pfizer); F.D. received fees from Biocodex for 2 lectures.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: François Dubos, MD, PhD, Pediatric Emergency Unit & Infectious Diseases, CHU Lille, 2 av. Oscar Lambret, F-59000, Lille, France. E-mail:

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