Recurrent Bacterial Meningitis in Pediatric Patients with Anatomical Defects

Lee, Eun; Lee, Eun Hye; Yum, Mi Sun; Ko, Tae Sung

Abstract

PURPOSE
Recurrent bacterial meningitis represents the reappearance of two or more episodes of meningitis by a different or same organism after an intervening period of full convalescence. Predisposing factors for recurrent bacterial meningitis include developmental or traumatic anatomical defects or immunodeficiencies. The purpose of this study was to characterize recurrent bacterial meningitis in children.
METHODS
We identified 81 cases of bacterial meningitis diagnosed at the Asan Medical Center Children's Hospital between January 1999 and March 2009. We conducted retrospective reviews for children (below 18 years of age) with recurrent bacterial meningitis who had been diagnosed both by latex agglutination and positive cerebrospinal fluid (CSF) cultures.
RESULTS
Among 81 cases, 4 patients were identified as having recurrent bacterial meningitis, among whom 13 episodes of meningitis were identified. Two episodes occurred in 2 patients, 2 in 1 patient, and 6 in 1 patient. Three patients had inner ear anomalies with CSF leakage and 1 patient had a traumatic CSF fistula, representing predisposing factors. Of the 13 episodes, Streptococcus pneumoniae was the causative agent in 10 episodes and Hemophilus influenzae and Streptococcus. mitis were the other causative organisms. After the second case of meningitis, successful repair of CSF leakage prevented further development of meningitis in 3 patients. Despite several repair operations for CSF leakage, 1 patient died of cerebral edema during the 6th episode of meningitis. In addition, 2 patients experienced further episodes of meningitis after vaccination against pneumococcus or H. influenzae type B in our study.
CONCLUSION
Identification and proper management of conditions that predispose children to recurrent bacterial meningitis are essential to prevent further, potentially lethal infections.