Cerebrospinal fluid appearance as a diagnostic criterion for suspected bacterial meningitis in children less than five years in East Africa.

Abstract

The study focused on the sensitivity and specificity of cerebrospinal fluid appearance and white blood cell (WBC) count as potential laboratory screening indicators compared to culture method. This is because Cerebrospinal fluid (CSF) culture facilities are expensive and difficult to maintain in resource poor laboratory settings yet this is the gold standard for diagnosis. Early signs of meningitis are often subtle and nonspecific resulting in unacceptably high mortality and morbidity rates in children, especially those from developing countries where rapid access to medical attention and resources is unavailable. Diagnosing acute bacterial meningitis in children is likely to be missed in a third of cases at district hospitals in sub-Saharan Africa where adequate and reliable laboratory resources are lacking. Most affected patients now survive due to antibiotic use, though many children still die or suffer permanent neurologic sequelae as a result of bacterial meningitis. Data was gathered from samples collected from children aged below five years admitted at the participating hospitals between the time periods 2001 to 2008. This was carried out retrospectively from the period 2001 to 2005 and prospectively from 2006 to 2008. A total of 32,152 samples were collected for the entire period. Of the 29,153 samples collected with reported appearance, 4.49% of them were positive for pathogenic organisms out of which three micro-organisms were of most interest to the surveillance; Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis that accounted for 50.7% of the positive isolates. Turbid appearance had a sensitivity of 72% (95% CI 69 – 74) and specificity of 96%. Clear appearance had a sensitivity of 18% (95% CI 16.1 – 20.3) and a specificity of