Risk Factors in Children Older than 5 Years with Pneumococcal Meningitis: Data from a National Network.

INTRODUCTION: The occurrence of meningitis in children > 5 years old may be associated with specific predisposing factors that can be anatomic, such as cerebrospinal fluid (CSF) fistula or breach, or related to genetic susceptibility or N inborn or acquired immunologic defect. This study aimed to assess the anatomical and immunologic risk factors in children > 5 years old with pneumococcal meningitis and prospectively enrolled in the French national meningitis network.

METHODS: We analyzed all data for children 5 to 15 years old with a diagnosis of pneumococcal meningitis between 2001 and 2013. We describe the frequency and typology of the anatomic or immunologic risk factors, the clinical features and the pneumococcal serotypes.

MAIN RESULTS: Among the 316 patients with pneumococcal meningitis, the mortality rate was 9.5%, and 23.1% of cases presented complications (abscess, coma, hemodynamic failure, thrombophlebitis cerebral or deafness). In total, 108 children (34%) showed risk factors, the most frequent being anatomic: 70 cases (22.8%) were related to a CSF breach or fistula and 55 (17.9%) to immunodeficiency, primary or acquired. Serotype data were available for 207 pneumococcal isolates (65.5%). The most frequent serotypes were 3, 18C, 19A, and 19F between 2001 and 2009 and 19F, 3, 19A, 12F, 22F, 17F and 24F after 2009.

DISCUSSION: We describe the largest cohort of children > 5 years old with pneumococcal meningitis. One third of the children had risk factors justifying a complete immunologic and radiologic work-up.