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Predictors of Acute Bacterial Meningitis in Children from a Malaria-Endemic Area of Papua New Guinea


Laman, M; Manning, L; Greenhill, AR; Mare, T; Michael, A; Shem, S; Vince, J; Lagani, W; Hwaiwhanje, I; Siba, PM; Mueller, I; Davis, TME
2012-02
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
Journal Article
86
2
240-245
Predictors of acute bacterial meningitis (ABM) were assessed in 554 children in Papua New Guinea 0.2-10 years of age who were hospitalized with culture-proven meningitis, probable meningitis, or non-meningitic illness investigated by lumbar puncture. Forty-seven (8.5%) had proven meningitis and 36 (6.5%) had probable meningitis. Neck stiffness, Kernig's and Brudzinski's signs and, in children < 18 months of age, a bulging fontanel had positive likelihood ratios (LRs) >= 4.3 for proven/probable ABM. Multiple seizures and deep coma were less predictive (LR = 1.5-2.1). Single seizures and malaria parasitemia had low LRs (<= 0.5). In logistic regression including clinical variables, Kernig's sign and deep coma were positively associated with ABM, and a single seizure was negatively associated (P <= 0.01). In models including microscopy, neck stiffness and deep coma were positively associated with ABM and parasitemia was negatively associated with ABM (P <= 0.04). In young children, a bulging fontanel added to the model (P < 0.001). Simple clinical features predict ABM in children in Papua New Guinea but malaria microscopy augments diagnostic precision.
AMER SOC TROP MED & HYGIENE
CEREBRAL MALARIA; DIAGNOSTIC-ACCURACY; CLINICAL-FEATURES; EPIDEMIOLOGY; CHLORAMPHENICOL; PREVENTION; BACTEREMIA; DISEASE; AFRICA; ALASKA
Infection and Immunity
10.4269/ajtmh.2012.11-0312
Copyright ©The American Society of Tropical Medicine and Hygiene

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Creation Date 2012-02-01 12:00:00