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Meningitis without a petechial rash in children in the Hib vaccine era.
J Infect. 2004 Nov; 49(4):297-301.JI

Abstract

AIMS

(1) To determine the causes of meningitis in children immunized with Hib vaccine, presenting without a non-blanching rash; (2) to review the use of dexamethasone in this group.

METHOD

Retrospective review of all children with more then 10 white cells/mm(3) in their cerebrospinal fluid (CSF), admitted between January 1998 and August 2002. Children were excluded if they had a non-blanching rash on admission or if their discharge diagnosis was not meningitis. Local guidelines recommended dexamethasone to be given before antibiotics for children with meningitis and no rash.

RESULTS

One hundred and eight children were identified. Causes of proven meningitis were: viral 41 (enterovirus 40), bacterial 22. CSF culture or PCR was the only diagnostic test in 31 children. Dexamethasone was given to 16 children. Length of admission was shorter in children with viral compared with bacterial meningitis (4 vs 8 days; P < 0.0001).

SUMMARY

Viral meningitis is the commonest cause of meningitis without rash. Enteroviral PCR was the most useful test and needs to be widely available. Confirmation of enteroviral meningitis allowed early discharge. Few children were given dexamethasone, but only 5/108 may have benefited.

CONCLUSIONS

The most common cause of meningitis without a rash in British children is enterovirus. The use of dexamethasone in children with meningitis without a rash should be reconsidered or, at least, individualised.

Authors+Show Affiliations

Department of Child Health, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15474627

Citation

Makwana, N, et al. "Meningitis Without a Petechial Rash in Children in the Hib Vaccine Era." The Journal of Infection, vol. 49, no. 4, 2004, pp. 297-301.
Makwana N, Nye K, Riordan FA. Meningitis without a petechial rash in children in the Hib vaccine era. J Infect. 2004;49(4):297-301.
Makwana, N., Nye, K., & Riordan, F. A. (2004). Meningitis without a petechial rash in children in the Hib vaccine era. The Journal of Infection, 49(4), 297-301.
Makwana N, Nye K, Riordan FA. Meningitis Without a Petechial Rash in Children in the Hib Vaccine Era. J Infect. 2004;49(4):297-301. PubMed PMID: 15474627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meningitis without a petechial rash in children in the Hib vaccine era. AU - Makwana,N, AU - Nye,K, AU - Riordan,F A I, PY - 2003/10/19/accepted PY - 2004/10/12/pubmed PY - 2004/12/22/medline PY - 2004/10/12/entrez SP - 297 EP - 301 JF - The Journal of infection JO - J Infect VL - 49 IS - 4 N2 - AIMS: (1) To determine the causes of meningitis in children immunized with Hib vaccine, presenting without a non-blanching rash; (2) to review the use of dexamethasone in this group. METHOD: Retrospective review of all children with more then 10 white cells/mm(3) in their cerebrospinal fluid (CSF), admitted between January 1998 and August 2002. Children were excluded if they had a non-blanching rash on admission or if their discharge diagnosis was not meningitis. Local guidelines recommended dexamethasone to be given before antibiotics for children with meningitis and no rash. RESULTS: One hundred and eight children were identified. Causes of proven meningitis were: viral 41 (enterovirus 40), bacterial 22. CSF culture or PCR was the only diagnostic test in 31 children. Dexamethasone was given to 16 children. Length of admission was shorter in children with viral compared with bacterial meningitis (4 vs 8 days; P < 0.0001). SUMMARY: Viral meningitis is the commonest cause of meningitis without rash. Enteroviral PCR was the most useful test and needs to be widely available. Confirmation of enteroviral meningitis allowed early discharge. Few children were given dexamethasone, but only 5/108 may have benefited. CONCLUSIONS: The most common cause of meningitis without a rash in British children is enterovirus. The use of dexamethasone in children with meningitis without a rash should be reconsidered or, at least, individualised. SN - 0163-4453 UR - https://www.unboundmedicine.com/medline/citation/15474627/Meningitis_without_a_petechial_rash_in_children_in_the_Hib_vaccine_era_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163445303001981 DB - PRIME DP - Unbound Medicine ER -