SPECIFICITY AND SENSITIVITY OF SIGNS AND SYMPTOMS IN BACTERIAL MENINGITIS
Abstract
In a prospective study extended along an 8 months period from July 2006-Feb .2007 , 116 patients were collected , from the admission to the department of pediatrics , Maternity and children hospital in Nassiryia city (MCH), with suspicion of meningitis .they were clinically evaluated for the signs and symptoms of meningitis , and the CSF analysis was the final diagnostic tool for meningitis .the patients were divided into 6 age groups ,and the sensitivity , specificity ,positive predictive value and the accuracy for the symptoms and signs of meningitis were calculated for each age group . In the age group <1 month of age :convulsion was the most sensitive symptom, while lethargy was the most sensitive sign . In age group 1-6 months : fever and convulsion were the most sensitive symptoms , while bulging fontanel , lethargy and irritability were the most sensitive signs . In the age group 7-12 months : vomiting ,fever and convulsion were the most sensitive symptoms , while bulging fontanel, lethargy and neck rigidity were the most sensitive signs . In the age group 1-5 years : vomiting headache ,fever and anorexia were the most sensitive symptoms , while lethargy and neck rigidity were the most sensitive signs . In the age group 6-10 years : vomiting ,headache and fever were the most sensitive symptoms , while neck rigidity was the most sensitive sign .Irritability ,Kernig sign and back pain were less sensitive signs . In the age group 6-15 : vomiting ,headache and fever were the only sensitive symptoms while lethargy, Kering sign and neck rigidity were the only sensitive signs From this study we can conclude that for each age group there are some signs and symptoms sensitive for the diagnosis of meningitis different from the other age groups ..Performing lumber puncture in doubtful cases of meningitis is better than missing a case of meningitis with it is sequelae.References
Fleisher GR: infectious disease emergencies .in:Fleisher GR, Ludwig S,Eds. Textbook of Pediatric Emergency Medicine .3rd Ed. Baltimore ,MD:Williams &Wilkins Co;1993.
Bell We ,McGuinness GA: Suppurative central nervous system infections in the neonate .Semin Perinatal 6:1,1982.
Kliegman RM,Feigen RD. Acute bacterial meningitis beyond the neonatal period .In :Behrman RE,et al ,Eds. Nelson textbook of Pediatrics .Philadelphia ,PA:WB Saunders Co;2000:683.
McCarhy PL,Jekel JF ,Stashwik CA, et al .further definition of history and observation variable in assessing febrile children .pediatrics .1991;67:687-693.
Kaplan SL. Recent advances in bacterial meningitis .ADV Pediatr infect Dis.1989;4:83-110.
David G Perkin , Fred H Hochberg , Douglas C Miller. Clinical neurology . Bacterial meningitis .The C .V.Mosby company .Newyork .2001:433.
Rothrock SG , Green SM , Wren J, Letai D , et al .pediatrics bacterial meningitis : is prior antibiotics therapy associated with an altered clinical presentation ?Ann Emerg Med 1999;21(20:146-152.
Rennick G, Shann F,D CampoJ. Cerebral herniation during bacterial meningitis in children .Br Med. J 1998;306:953-955.
Feigin RD, McCracken GH,Klein JO :Diagnosis and management of meningitis .Pediatr Infection Dis J 11:785,1998.
Feigin RD ,Shackelford PG .value of repeat lumber puncture in the differential diagnosis of meningitis .N Engl J Med 1993;289:571-4.
Durack DT .Spanos A. End-of-treatment spinal tap in bacterial meningitis .Is it worthwhile ? Jama 1982 ; 284:75-8.
Davis SD ,Hill HR ,Feigl P, Arnstein EJ. Partial antibiotic therapy in Hemophilus influenza meningitis .It is effect on cerebrospinal fluid abnormalities .Am J Dis Child 1995;129:802-7.
Talan DA,Hoffman JR, Yoshikawa TT,Overturf GD .Role of empiric parenteral antibiotics prior to lumber puncture in suspected bacterial meningitis : state of art {see comment }.Rev Infect Dis 1988;10:365-76.
Hoban DJ ,Witwicki E,Hammond GW.Bacterial antigen detection in cerebrospinal fluid of patients with meningitis .Diagn Microbial Infect Dis 1993 ;3:373-79.
Armitage P ,Berry G,Statistical method in epidemiology .statistical methods in medical research .Oxford :Blachwell .1997:472-8.
Charles G .Probe .Infection of central nervous system .In: Behrman RE ,et al ,Eds .Nelson Textbook of Pediatrics. Philadelphia , PA : WB Saunders CO; 199:681 .
Kleine JO ,Feigin ,RD , McCracken GH ,Jr, et al .Task force report on diagnosis and management of meningitis .Pediatrics 1993; 78:959-82.
Karen L Roos . bacterial meningitis in Childhood .American Academy of Neurology ,52nd Annual meeting .San Diego .Marathon Multimedia .2000.
