Bakteriální meningitidy nezjištěné etiologie u dětí do pěti let věku

Objective: The objective of the work was to evaluate the course, complications and consequences of bacterial meningitis caused by unknown pathogens in children under 5 years during the period from 1985 -1999. An attempt to analyze the causes of negative results of cultivation examinations. Methods: During the investigation period at the Clinic for Infectious Diseases Faculty Hospital Plzeň a total of 5780 children aged 5 weeks to 5 years were hospitalized. From the total number 150 (2.6%) were admitted on account of bacterial meningitis. In 123 (85%) in the etiology of the disease the pathogenic organism was revealed, in another 14 cases the disease was evaluated as meningococcal meningitis or sepsis based on clinical symptoms and epidemiological circumstances. In a group of 9 children where it was not possible to detect the pathogen risk factors for the development of bacterial meningitis were evaluated, as well as the clinical course of the disease, treatment, complications and sequelae of the disease. The reasons for the negative microbiological examinations were considered. Results: During the 15-year period a total of 9 children were admitted where it did not prove possible by any of the available cultivation and non-cultivation microbiological methods to detect the causal agent. The mean age of the group was 17.2 months, the youngest patient was two months old. A total of 5 patients were referred to hospital with the corresponding diagnosis. The mean period before establishment of the diagnosis was 61 hours. None of the patients died, the course was in two patients complicated by mastoiditis, in one by ataxia. Nosocomial complications were observed in four other children. On long-term follow up the disease did not leave any permanent sequelae. Conclusion: The clinical course of bacterial meningitis in the investigated group was as compared with Haemophilus influenzae type b, meningococcal and pneumococcal disease milder, the disease did not leave any permanent sequelae. In all patients already before assessment of the diagnosis antibiotic treatment was started lasting on average 72 hours. This fact is the probable explanation why cultivation methods and rapid non-cultivation methods failed. To improve the etiological diagnosis of bacterial meningitis in this case a major contribution would be evidence of DNA of the microbial agent using PCR methods which are gradually being introduced in the NRL in Prague.