Læknablaðið : fylgirit - 01.08.1981, Page 58

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hærri en við H. iníl. meningitis eða 5—10%,8
2122 eru varanlegar afleiðingar mun sjald-
gæfari en i öðrum mengisbólgutegundum og
sjást aðeins hjá 7—13%.
Af öllum sjúklingunum I þessu uppgjöri
sýndu aðeins 4% greinilegar menjar sjúk-
dómsins við brottför. Þetta virðist grunsam-
lega lág tala og raunar alls óvitað, hvort öll
kurl eru hér til grafar komin. Þyrfti, ef vel
væri, að endurmeta nákvæmlega alla þessa
sjúklinga m.t.t. starfrænna truflana frá
taugakerfi og þar með minniháttar náms-,
hegðunar- og hreyfitruflana.
Fyrir utan þýðingu skjótrar greiningar og
meðhöndlunar, sem allir geta verið sammála
um, virðast flestir hallast að þvi, sem hér
kemur fram, að tegund sýklalyfjameðferðar
breyti harla litlu um afdrif og afleiðingar.
Hjnsvegar er mjög liklegt, að verulega bætt
stoðmeðferð á seinni árum, sem einkum
miðar að því að halda niðri heilabjúg og
krömpum, sjá fyrir nægu súrefni og sykri
til heilans og viðhalda vökva- og blóðsalta-
jafnvægi, skipti meginmáli um bættar lífs-
horfur og ekki síður fækkun sjúkdóms-
menja.
Höfundur þakkar Kristínu E. Jónsdóttur,
lækni, góðar ábendingar og upplýsingar og
Magnúsi L. Stefánssyni, lækni, skrá yfir
orsakasönnuð mengisbólgutilfelli á barna-
deild F.S.A. 1969—78.
SUMMARY
Bacterial meningitis til children. A 10 years
survey from the pediatric department, St.
Joseph’s Hospital, Landakot, Reykjavík 1969—
1978.
78 children with bactericd meningitis, 44
boys and 34 girls, were admitted in the period
1969—1978. Their age ranged from 12 days to
12 years, with 92% under 6 years of age. Four
patients were less than one month of age.
Bacterial etiology was proven in 86%. Forty-
five per cent of infections were caused by N.
meningitidis, 34,6% by H. influenzae and 6,4%
by S. pneumoniae.
Blood cultures were positive in 50% of N.
meningitidis patients, 85% of H. influenzae
patients, 75% of S. pneumoniae patients and all
of three E. coli patients. Naso-pharyngeal cul-
tures revealed indentical organism in 38% of
N. meningitidis patients and 55% of H. influen-
zae pátients.
Cerebrospinal fluid cultures were negative in
nine cases, despite pleocytosis. By Gram stain
(4), blood cultures (4) and nasopharyngeal
culture in addition to petecchiae (1), they
were all classified as belonging to N. meningi-
tidis, where these diagnostic measures were
found to be of greateSt help.
The overall mortality was slightly under 9%.
According to respective etiology, N. meningi-
tidis had 8,6% mortality, H. influenzae zero,
S. pneumoniae 20% and E. coli 66,7% mortality.
Only 4% of patients are known to have major
sequelae from the disease. No significant differ-
ence in mortality or general outcome was
found between two treatment groups, one con-
sisting of ampicillin alone as the initial anti-
bacterial treatment (38 pts), the other one
consisting of multiple antibacterial drugs (40
pts.).
Since the discovery of the first and so far
only ampicillin resistant strain of H. influenzae
type B from the cerebrospinal fluid in Iceland,
isolated in October 1978, ampicillin alone has
been abandoned as initial treatment.
No less important than effective antibacterial
treatment seems to be a proper attention given
to increased intracranial pressure, convulsions,
anoxia, water-electrolyte imbalance and hypo-
glycemia. Glycerol was found to be an effec-
tive drug to treat cerebral edema and possibly
every child with bacterial meningitis should get
prophylactic anticonvulsive treatment the first
few days, for better general outcome.
The average incidence of bacterial meningitis
in children in Iceland seems to be about 8—10
patients per 100.000 inhabitants per year (over-
looking epidemics) with appears to be some-
what higher than reported from the Scandi-
navian countries.
HEIMILDIR
1. Alon, U. & al.: Neurological sequelae of
septic meningitis. A foliow up study of 65
children. Isr. J. Med. Sci., 15:512, 1979.
2. Arnórsson, V.: Meningitis becterialis i börn-
um — 15 ára uppgjör. Læknablaðið, 60-197,
1974.
3. Baird, D.R. & al.: Mortability from Pneumo-
coccal Meningitis. Lancet, 7999:1344, 1976.
4. Brook, I. & al.: C.S.F. Lactic acid for dif-
ferential diagnosis of meningitis. Lancet,
8124:1035, 1979.
5. Dahnsjö, H. & al.: Tone Audiometry Control
of Children treated for Meningitis, with
Large Intravenous Doses of Ampicillin. Acta
Pædiatr. Scand., 65:733, 1966.
6. Davies, J.N.P.: Mortality from Pneumo-
coccal Meningitis. Lancet, 8005:255, 1977.
7. Dodge, P.R. & Swartz, M.N., Bacterial
Meningitis -— a Review of Selected Aspects.
N. Engl. J.Med., 272:725, 1965.
8. Ellsworth, J. & al.: Meningococcal meningi-
tis in children. CMA Journal, 120:155, 1979.
9. Feigin, R.D. & al.: Prospective Evaluation
of Treatment of Hemophilus Influenzae
Meningitis. J. Pediatr., 88:542, 1976.
10. Gamstorp, I. & Klockhoff, I.: Bilateral,
severe, sensorineural hearing loss after