Pattern of sepsis and meningitis in a University Hospital

OBJECTIVE: To define the clinical and cerebrospinal fluid (CSF) criteria that establishes a diagnosis of sepsis and meningitis immediately on admission.

METHODS: One thousand children, aged one day to 13 years, presenting with acute onset of vomiting, fever, convulsion, and diarrhea to the Pediatrics Department, King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January 1997 to December 2000 were evaluated. Cases were subjected to history, clinical examination, and lumbar puncture (LP). On admission, chemical, cytological, and bacteriological examinations of blood and CSF were carried out. Patients were divided into sepsis (n=94) and meningitis (n=26) groups.

RESULTS: The most common age liable for LP was in the neonatal period (35.8%). Septic cases were more than meningitis (78.3% versus 21.7%). Neonates were the most commonly affected age in sepsis and meningitis; and the predominant symptom in all groups was vomiting. In meningitis, hemoglobin was less (p<0.05) while, blood white blood cell counts (WBCs) (p<0.05), blood neutrophils (p<0.05), CSF-chloride (p<0.000) and CSF-WBCs (p<0.001) were more than sepsis. In meningitis, a positive correlation was found between CSF-glucose with WBCs (r=0.52, p<0.05), neutrophils (r=0.49, p<0.05), and blood-glucose (r=0.56, p<0.01); and between CSF-WBCs and CSF-protein (r=0.55, p<0.01). In sepsis, a positive correlation was found between CSF-lymphocyte and CSF-red blood cell count (r=0.37, p<0.001).

CONCLUSION: More septic cases were admitted to the Pediatric Department through Emergency than meningitis cases. The most common pediatric patients liable to LP were neonates, and the most common presenting symptom was vomiting. Children with vomiting and convulsion and no organism in CSF must be carefully examined, and urine and blood culture must be collected. These children must be closely observed in hospital and re-evaluated by a pediatrician.