Only Half of Infants With Meningitis Show Traditional Signs of the Disease

LONDON -- February 28, 2018 -- Researchers at St George’s, University of London, say their new study shows the classic symptoms associated with bacterial meningitis are uncommon in young infants less than 3 months of age – the group at highest risk of the disease. The study is published in The Pediatric Infectious Diseases Journal.

Only around half of babies under 3 months of age who have bacterial meningitis display fever, which has for decades been the trigger for further medical investigations.

One of the study investigators, Paul Heath, MD, Vaccine Institute & Institute for Infection and Immunity, St George's, University of London, London, United Kingdom, said: “The classic features of meningitis were uncommon in many cases. The symptoms displayed by young infants when they are seen by doctors at first in hospital are often non-specific and only half of cases showed signs of a fever.

“Guidelines focusing on serious infections - including meningitis - in children have been introduced in the UK and the USA but all specify fever as a key feature of infection.

“Unfortunately, neither the rates of bacterial meningitis in babies, nor the numbers of deaths, have changed since the 1980s.

“Clinicians must, therefore, still consider bacterial meningitis in the diagnosis of an unwell infant that doesn’t present with fever.”

The study, funded by charity Meningitis Research Foundation (MRF), involved 263 infants across the United Kingdom and Ireland and found that fever (temperature above 38oC) was reported in only 54% of cases, seizures in 28%, bulging fontanelle in 22%, coma in 6% and neck stiffness in only 3%.

In the United Kingdom, babies under 3 months of age are 70 times more likely to get bacterial meningitis than adults. Newborn babies are at the highest risk of all.

The study found that infants who did present with fever tended to be older than infants without fever. The median age for this symptom was around 21 days old. Of note, 52% of the infants without fever had other features suggestive of bacterial meningitis, such as apnoea (33%), seizures (32%), bulging fontanelle (16%), coma (7%) and neck stiffness (3%).

Earlier research from the same experts found there to be in the region of 350 cases of bacterial meningitis in infants under 3 months of age per year in the United Kingdom and Ireland. Group B streptococci and Escherichia coli remain the main causes of bacterial meningitis in this age group.

The study suggests that there should be a low threshold for performing investigations on young infants when they arrive at hospital. Common features were found to be poor feeding, lethargy and irritability, all of which can be difficult to distinguish from mild illness.

Vinny Smith, MRF, said: “Young babies are particularly vulnerable to bacterial meningitis. Meningitis and septicaemia are deadly diseases that strike without warning. One in 10 people affected will die and a third of survivors will be left with after-effects, some as serious as brain damage, amputations, blindness or hearing loss.

“Based on this research, we have collaborated with the study investigators to create a training package aimed at doctors and health professionals to aid rapid diagnosis and clinical management.

“The package includes an eTool to help clinicians recognise clinical features of bacterial meningitis in young infants; a lumbar puncture information sheet to help doctors explain this procedure to parents; and an algorithm to aid management of bacterial meningitis. We hope that it can ultimately improve outcomes for this vulnerable age group. We have also updated our symptoms information for parents so that they know not to rely on fever alone as the main symptom to look out for in babies.”

Infants with bacterial meningitis in the United Kingdom and Ireland were identified through the British Paediatric Surveillance Unit, laboratory surveillance and meningitis charities.

Reference: doi: 10.1097/INF.0000000000001917.

SOURCE: St George’s, University of London
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