Presentation and outcome of sporadic acute bacterial meningitis in children in the African meningitis belt: recent experience from northern Nigeria highlighting emergent factors in outcome.

Sixty-six (19.4%) of 341 acutely ill infants and children (> 1 mo-15 yr old) who had a lumbar puncture (LP) done during an inter-epidemic period had bacterial meningitis (BM). No clinical feature was sufficiently characteristic of the presence of BM. Twenty (30.3%) of the 66 patients with BM lacked typical signs of meningitis at the time of diagnosis whereas 61 (22.2%) of the 275 with other illnesses had signs. Three (4.6%) of the 66 patients with BM were discharged against medical advice, 31 (47%) survived intact and 16 (24.2%) each died or survived with sequelae. Case fatality rate was significantly higher in children with coma, focal extracranial infections, delayed diagnosis of BM after admission, irregular administration of antibiotic drugs and treatment with dexamethasone. Among survivors, sequelae rate was significantly higher in children with delayed presentation, convulsions, coma, and prolonged hospitalisation (> 10 days); sequelae rate in patients with convulsions was significantly higher in those with complex convulsions and convulsions occurring after 24 hours of treatment. Irregular provision of drugs by parents and delay in the diagnosis of BM after admission are emergent factors which, in addition to the well known factors of malnutrition and delayed presentation, further worsen the prognosis of BM. A more liberal policy in the use of LPs in acutely ill children is advocated to reduce the risk of missed diagnosis.