Cases of meningitis admitted to zarqa gov. Hospital year 2013

1. ً‫ال‬‫أو‬ ‫األردن‬

2. CASES OF ACUTE MENINGITIS
IN CHILDREN, ADMITTED AND
TREATED IN ZARKA GOV.
HOSPITAL.
A ONE YEAR STUDY PERIOD

3. Performed by
Dr.Ghassan A Shakkoury
Consultant pediatrician
Zarka gov. hospital

4. Introduction
Acute Meningitis may be septic or aseptic
COMMON CAUSES OF ASEPTIC
MENINGITIS ARE
1- viral infections( most common)
2-partially-treated" bacterial meningitis
3-tuberculous or fungal meningitis.

5. INTRODUCTION
( 90%)viral meningitis cases are due to
non-polio ENTEROVIRUSES
1-COXSACKIE AND ECHO VIRUSES (50% )
2- HERPES, MUMPS AND OTHER VIRUSES
Viral meningitis is milder
Occurs mainly in the
a-late summer and early fall
b- in children under the age of 5 years.

6. Objective
TO
Establish the SEASONALITY, CLINICAL
FEATURES, AND PERCENTAGE of ASEPTIC
MENINGITIS cases among Jordanian
children in zarka governorate
THIS MAY
Decrease the unnecessary empiric use of
antibiotics and the length of hospital stay.

7. BY
1- A special questionnaire which was filled by
direct interview with the parents
2-Data recorded in the patients file
Cases were divided to three groups
according to their age
(1 month – 2 years , 2- 5 years and more than
5 years )

9. Setting and
participants
All children admitted to pediatric
department (Zarka gov. hospital) and
diagnosed as having
MENINGITIS
in the one year period (between 1/12/
2013 t0 30/11/2014 )

10. clinical criteria for
diagnosis
1- CLINICAL PICTURE
SUGGESTIVE OF MENINGITIS
IN ADDITION TO THE
2-PRESENCE OF PLEOCYTOSIS
(high WBC number in CSF)

11. PROSPECTIVE EXCLUSION
CRITERIA
• Children below one month age
• Children treated empirically (without
performing lumber puncture.
(PRESENCE OF contraindications for
performing L.P )

12. FIVE WERE EXCLUDED FROM
THE STUDY
1- Four because their ages were below one
month
2- The other one because L.P was not
performed and was treated empirically.

13. Statistical analysis
Descriptive in addition to some
inferential statistics such as t-
test,ANOVA and odds ratio
calculations were used to analyze the
results.

14. RESULTS
All recorded cases were 206.
Five were excluded as was mentioned before
Male to female ratio 116: 85 =
1.4: 1
Mean age of male patients was not
significantly different from mean age of
female patients
(3.1 vs. 3.2 years respectively ) P- VALUE =
0.84

15. TOTAL
M : F
RATIO
SEX
AGE
GROUP
FEMALE
S
MAL
ES
107
1.4 : 1
45
62
1/12 - 2
YEARS
37
1.2 : 1
16
21
2 - 5 YEARS
57
1.3 :1
24
33
MORE
THAN 5 Y
201
1.4 : 1
85
116
TOTAL

16. RESULTS (Continue)
<2YEARS
2 - 5 YEARS
>5YEARS
FIG.2 distribution of meningitis cases according to age
(MOST CASES ARE BELOW 2 YEARS OF AGE ( 53 %) )

17. RESULTS (Continue)
Seasonal distribution of meningitis cases
according to the age
0
20
40
60
80
LESS
THAN 2 Y
2 - 5 Y 5 YOR
MORE
TOTAL
WINTER
SPRING
SUMMER
AUTUMN
WINTER
SPRING
SUMMER
AUTUMN

18. Most cases of meningitis mainly occur during summer and
autumn (55%)
The least are in spring (20%)
0
10
20
30
40
50
60
70
winter spring summer autumn
TOTAL

19. RESULTS (Continue)
FREQUENCY OF PRESENTING COMPLAINTS IN
DIFFERENT AGE GROUPS
FEVER was a universal presenting complaint in the three age
groups, VOMITING was frequent in the three age groups,
CONVULSIONS mainly decrease with increasing of age and
HEADACHE is an increasing complaint by age
0%
20%
40%
60%
80%
100%
120%
1M - 2 Y 2 - 5 Y 5 Y OR MORE
FEVER
VOMITING
SEIZURES
POOR FEEDING
HEADACHE
PURPURIC RASH

20. RESULTS (Continue)
WBC in CSF was significantly different in the three
age groups ( P-VALUE = 0.046
CSF
SUG
AR/S
.SUG
AR
MEAN
S.SUG
AR
mg/dl
MEAN CSF SUGAR
mg/dl
MEAN CSF
PROTEIN
mg/dl
MEAN WBC
NUMBER
AGE GROUP
60 %
89.6
53.3
32.5
107
1MONTH
– 2
YEARS
63%
87
54.4
33.9
331
2 - 5
YEARS
57%
93.6
53.4
34
158
5 YEARS
OR
MORE
P-
VALU
E =
0.47
P-VALUE = 0.94
P-VALUE=
0.89
P – VALUE =
0.046
ANOVA
TEST

21. RESULTS (Continue)
CSF CULTURE AND LATEX IN THE THREE AGE GROUPS
ONE PATIENT (MALE AGE 5 YEARS CAME DURING MARCH 2008 ) OF
THE 201 CASES ( 0.005 ) HAS HAD A POSITIVE CSF CULTURE (
STREPT. PNEUMONIA ). CSF LATEX WAS NEGATIVE IN ALL CASES
CSF LATEX
CSF CULTURE
AGE GROUP
NEGATIVE IN ALL
PATIENTS
NO GROWTH IN ALL PATIENTS
1MONTH – 2
YEARS
NEGATIVE IN ALL
PATIENTS
NO GROWTH IN ALL PATIENTS.
2 - 5 YEARS
NEGATIVE IN ALL
PATIENTS
ONE PATIENT. ONLY POSITIVE FOR
STREPT. PNEUMONIA
5 YEARS OR
MORE

22. RESULTS (Continue)
VACCINATION
ANTIBIOTI
C
ANTIBIOTIC
AGE
GROUP
NOT
COMPLE
TE
UP TO DATE
GIVEN
NOT GIVEN
4
103
39
68
1 M - 2 YEARS
N = 107
0
37
21
16
2 - 5 YEARS
N= 37
0
57
23
34
5 YEARS OR MORE
N= 57
4 ( 2% )
197 ( 98% )
83 ( 41% )
118 (59%)
TOTAL`
41% OF ALL PATIENTS WERE GIVEN ANTIBIOTICS PRIOR
TO ADMISSION. MOST PATIENTS ( 98%) WERE
VACCINATED UPTO DATE.

23. RESULTS (Continue)
ANTIBIOTICS USED IN ALL PATIENTS
DURING PERIOD OF HOSPITALIZATION
0%
20%
40%
60%
80%
100%
120%
3'D
GENERATION
CEPHALOSPOR
INS
APMICILLIN
ADDED
VANCOMYCIN
ADDED

24. 0%
10%
20%
30%
40%
50%
60%
70%
1 M - 2 Y 2 Y - 5 Y 5 Y OR MORE TOTAL
CEFTRIAXONE
CEFOTAXIME
CEFTAZIDIME
AMPICILLINE ADDED
VANCOMYCINE ADDED
ANTI BIOTICS USED IN EACH AGE GROUP DURING
HOSPITALIZATION
RESULTS (Continue)

25. DAYS OF ADMISSIONS AND AMMOUNT OF
ATIBIOTICS USED
TOTAL
AMOUNT IN
GRAMS
MEAN AMMOUNT OF
CEPHALOSPORINS GIVEN IN
GRAMS/ PATIENT DURING
ADMISSION (120mg/kg/day)
MEA
N
B.W
Kg
MEA
N
DAY
S OF
ADM
ISSI
ON
AGE GROUP
1123
10.5 grams/ patient
8
11
1 MONTH – 2
YEARS
n =107
555
15 grams/patient
14
9
2 – 5 YEARS
n = 37
1197
21 grams /patient
25
7
5 YEARS OR
MORE n = 57
2875
TOTAL

26. AN ECONOMIC COST ANALYSIS OF AL KARAK
HOSPITAL JUNE 2002
PREPARED BY: MINISTRY OF HEALTH, JORDAN
Costs of Daily Hospital Services Loaded With Admin/Finance
Costs (PEDIATRIC DEPARTMENT)
Loaded TC per
Adjusted
Patient Day
Total Costs
(TC) +
(Loaded
Admin/Fi
nance
(Loaded)
Costs
Total
Costs
Cost
Center
JD 64
JD 409,842
JD 95,120
JD
314,722
Pediatrics

27. TOTAL COST OF DAYS OF ADMISSIONS
TOTAL
COST OF
ADMISSI
ON DAYS
IN J.D
COST OF
BED PER
DAY IN
J.D
TOTAL
DAYS OF
ADMISSIO
N
MEAN
DAYS OF
ADMISSIO
N
AGE
GROUP
76505
65JD
1177
11
1 MONTH –
2 YEARS
n =107
21645
65JD
333
9
2 – 5 YEARS
n = 37
25935
65JD
399
7
5 YEARS
OR MORE n
= 57
124085
65JD
1909
TOTAL

28. Conclusion 1
1-MOST CASES WERE BELOW
2 YEARS OF AGE ( 53 %).
2- MOST CASES OCCURED DURING
SUMMER AND AUTUMN (55%)
3-The least were in spring (20%)

29. Conclusion 2
Mean number of WBC’s in CSF
was not high in the three age
groups
The highest was in the age group 2 - 5 years
then age group 5 y or more then age group 1
m – 2 y , 331 vs. 158 vs. 107 Respectively

30. Conclusion 3
MEANS OF CSF PROTEIN,
SUGAR AND SERUM SUGAR
were within the normal limits
among the three age groups

31. Conclusion 4
CSF CULTURE AND LATEX
WERE
RARELY POSITIVE

32. FINAL CONCLUSIONS
1-According to CSF ANALYSIS,
CULTURE, LATEX, AGE AND
SEASONAL DISTRIBUTION,
most patients
WERE SUSPECTED TO HAVE VIRAL
MENINGITIS.
2-ALL PATIENTS WERE TREATED AS
BACTERIAL MENINGITIS

33. FINAL CONCLUSION
• The use of expensive antibiotics, in
addition to the long stay in hospital for all
patients with meningitis produces a
HEAVY ECONOMIC BURDEN ON
M.O.H BUDGET

34. FINAL CONCLUSION
THIS BURDEN
can be greatly reduced if we have
- proper lab. investigations to exclude
bacterial meningitis ,
(at least CSF WBC’s dif.count and gram
stain in addition to culture and latex)
which
decreases days of admission per
patient and eliminates the irrational
use of antibiotics

35. All the love that history knows,
is said to be in every rose.
Yet all that could be found in two,
is less than what I feel for you.

36. THANK YOU