Clinical features of bacterial meningitis among hospitalised children in Kenya

Table 1 Diagnostic criteria for meningitis and organisms detected

Diagnostic criteria	Age <1year (n=33)	Age 1–4years (n=35)	Age ≥5years (n=30)	Total positives	Highest criteria for meningitis^a
CSF culture
Gram positive
Streptococcus pneumoniae	5	5	6	16^b	16
Haemophilus influenzae	3	2	0	5^c	5
Staphylococcus aureus	1	0	0	1^d	1
Gram negative
Escherichia coli	0	1	0	1	1
Klebsiella pneumonia	1	1	0	2^e	2
Non-typhoidal Salmonella sp.	2	0	0	2^f	2
Pseudomonas aeruginosa	1	0	0	1^g	1
Proteus mirabilis	1	0	0	1^h	1
Cryptococcus neoformans	0	0	2	2ⁱ	2
Total	14	9	8	31	31
Latex antigen test
Streptococcus pneumoniae	7	5	6	18	4^j
Haemophilus influenzae	2	3	0	5	3^k
Cryptococcus neoformans	0	0	2	2	1
Total	9	8	8	25	8
Gram-stain
Gram-positive cocci	8	8	5	21	4
Gram-negative rods	4	3	0	7	0
Total	12	11	5	28	4
Indian ink	0	0	1	1	0
CSF WCC ≥50 cells/μl	29	29	27	85	52^l
CSF/blood glucose ratio <0.1	7	5	3	15	3
Total					98

^aHierarchical order of criteria for meningitis: (i) positive CSF culture for a known pathogen, (ii) positive CSF antigen test, (iii) an organism observed on CSF microscopy (Gram stain or Indian Ink), (iv) CSF leucocyte count ≥50 cells/μL, and (v) CSF to blood glucose ratio <0.1
^b14/16 had WCC ≥50 cells/μl, 14/16 had positive S. pneumoniae antigen test, 14/16 had positive Gram stain, and 5/16 had CSF/blood glucose ratio <0.1
^c5/5 had WCC ≥50 cells/μl, 2/5 had positive H. influenzae antigen test, 3/5 had positive Gram stain, and 3/5 had CSF/blood glucose ratio <0.1
^dHad WCC ≥50 cells/μl and positive Gram stain
^e1/2 had WCC ≥50 cells/μl and positive Gram stain
^f1/2 had WCC ≥50 cells/μl and positive Gram stain. 1/2 had CSF/Blood glucose ratio <0.1
^gHad WCC ≥50 cells/μl and positive Gram stain
^hHad WCC ≥50 cells/μl, positive Gram stain and CSF/blood glucose ratio <0.1
ⁱ1/2 had WCC ≥50 cells/μl, positive Indian Ink stain and positive Cryptococcal antigen test
^j2/4 had WCC ≥50 cells/μl and positive Gram stain
^k3/3 had WCC ≥50 cells/μl, 2/3 had positive Gram stain, and 1/3 had CSF/blood glucose ratio <0.1
^l2/52 had CSF/blood glucose ratio <0.1

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