Meningitis neumocócica, ¿una enfermedad prevenible?

Objective. The aim of this study was to characterize the behavior of Streptococcus pneumoniae serotypes and to evaluate the impact of the 7-valent pneumococcal conjugate vaccine in Spain. Material and methods. A prospective study (47 months) was performed. Inclusion criteria were: patients aged between 0 and 18 years with a diagnosis of meningitis established either clinically on the basis of symptomatology or by cerebrospinal fluid (CSF) analysis, with isolation of S. pneumoniae in CSF and/or blood. Results. Sixteen cases of pneumococcal meningitis were studied. The mean age was 40.75 months. The most common symptoms were fever, behavioral changes and vomiting. Physical examination showed deterioration of the patient's overall health status, signs of meningism, and sensory disturbances. CSF analysis showed higher leukocyte counts in all patients. CSF and blood cultures were positive in 81.25% and 62.5% of cases, respectively. Sensitivity to penicillin was intermediate in 28.5% and 14.2% were resistant. Fever persisted for a mean of 44.8 hours after initiation of antibiotic treatment. The mean length of hospital stay was 16.87 days. Clinical complications included coma in 4 patients, convulsions in 2, electrolyte imbalance in 4 and stroke in 2 patients. The percentage of deaths was 12.5%. In 37.5% of cases there were no sequelae. Of the sequelae detected immediately prior to discharge, the most frequent was hypoacusia (56.3%). The most frequent serotypes were 6A, 19 and 23F (27.3%). Conclusions. Pneumococcal meningitis produces an exceptionally high incidence of complications/sequelae. The rate of pneumococcal resistance in our series was 42.8%. Vaccinal serotypes were more resistant to antibiotic treatment and caused most of the complications observed. Vaccination could have prevented up to 91% of cases.