This article is more than 5 years old. Information may no longer be current.
Time to death from meningitis depends on causative agent
Click Here to Manage Email Alerts
Time to death should be used as a measure of bacterial meningitis severity, according to data from a recent study of children from Angola.
Irmeli Roine, MD, PhD, of the University Diego Portales in Santiago, Chile, and colleagues, including Infectious Diseases in Children Editorial Board member Heikki Peltola, MD, PhD, evaluated 553 children aged 2 months to 12 years with confirmed bacterial meningitis to determine the time to death after initiation of antimicrobial treatment. Overall, 63% of patients survived and 37% died (n=206), according to the findings published in The Pediatric Infectious Disease Journal.
The median time to death was 18.5 hours, with 14% dying within the first 4 hours, 15% in 5 to 8 hours, 27% in 9 to 24 hours, 32% in 25 to 120 hours, and 12% following 120 hours.
Fewer days of illness before admission (P=.0002), lower cerebrospinal fluid glucose concentration (P=.003), higher pulse rate (P=.03), and lower systolic blood pressure (P=.04) were all associated with a shorter time to death.
Median time to death was 58 hours with the administration of an antibiotic as an infusion with high-dose oral paracetamol compared with a median time to death of 17 hours with an antibiotic as a bolus with an oral placebo.
Neisseria meningitidis led to the shortest time to death (median, 8 hours) and pneumococcal (median, 11.8 hours) while Haemophilus influenzae type b (Hib) meningitis led to a longer time to death (median, 26.8 hours). Forty-two percent of deaths due to pneumococcal meningitis occurred within the first 8 hours compared with 16% of deaths due to Hib meningitis.
Respiratory distress and convulsions on admission were common among all patients who died from 0 to 120 hours.
“Our present data suggest that time to death should be used as a further measure of severity,” the researchers wrote. “This could help explain, at least partly, the differences in adjuvant treatment efficacies in different populations. In centers like Luanda, many patients die before these treatment can take effect.”
Disclosure: Peltola reports financial ties with the Serum Institute of India. The study was funded by the Sigrid Juselius and the Paediatric Research Foundations, Helsinki, Finland.
Click Here to Manage Email Alerts