Gram negative bacillary meningitis in infants and children in developing countries.

Gram negative bacillary meningitis (GNBM) in postneonatal infants and children is two to three times more common in developed compared to developing countries. Other major differences are in the pattern of pathogens (mainly Klebsiella spp and Salmonella spp in developing versus E. coli in developed countries) and associated conditions (diarrhoeal diseases and malnutrition in developing versus neurosurgical and urinary tract abnormalities in developed countries). 12 (11.5%) of 104 cases of bacterial meningitis were due to GNB, including Klebsiella spp seven, E. coli, two and untyped Coliform spp, three; the age range of patients with GNBM was 3-24 months. Among seven completely evaluable patients, six presented after seven days of illness, five convulsed on or before admission, and six had accompanying respiratory or gastro-enteritic illnesses but none was severely malnourished or had associated neurosurgical or urinary tract abnormalities. Three patients died, three were discharged with sequelae and one without sequelae. The only significant difference between patients with GNBM and those with meningitis due to "usual" pathogens was the greater tendency to delayed presentation among the former (6/7 patients with GNBM versus 11/36 "usual" pathogens; p = 0.011); this was also the only striking difference in presentation when compared with patients from developed countries. The need for further studies, preferably multicentred, and for a revision of the traditional combination of gentamicin and ampicillin or chloramphenicol and ampicillin for the treatment of GNBM in developing countries is discussed.