Key words: bacterial meningitis, Haemophilus influenzae type b, Streptococcus pneumoniae, rapid diagnosis, childhood

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Key words: bacterial meningitis, Haemophilus influenzae type b, Streptococcus pneumoniae, rapid diagnosis, childhood

Fig.1 Distribution of the cases with bacterial meningitis by age and pathogens Chiba Children' s Hospital, Oct. 1988-Dec. 1998 (N =28)

Table 2 Laboratory diagnosis of bacterial meningitis Chiba Children's Hospital, Oct. 1988-Dec. 1998 * One of these strains was K1 antigen positive. ** false -positive on GBS. *** Urinary specimen for antigen detection was ~ 10 concentrated.

Table 3 Efficiency analysis of CSF antigen detection by using Latex particle agglutination in cases of (A) H. Influenzae type b (Hib) and (B) S. pneumoniae meningitis sensitivity 9/10= 90% specificity 12/12= 100% positive predictive value 9/9= 100% negative predictive value 12/13= 92% diagnostic efficiency (9 + 12)/22= 95% sensitivity 5/6= 83% specificity 18/18= 100% positive predictive value 5/5= 100% negative predictive value 18/19= 95% diagnostic efficiency (5 + 18)/24= 96%

7) Kaldor J, Asznowicz R, influenzae type b antigenuria in children. J Clin Pathol 1973; 33: 538-541. 8) Feigin RD, Wong M, Shackelford PG et al.: Countercurrent immunoelectrophoresis of urine as well as of CSF and blood for diagnosis of bacterial meningitis. J Pediatr 1976; 89: 773-775. 10) Adams WG, Deaver KA, Cochi SL et al.: Decline of Childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era. JAMA 1993; 269: 221-226. 11) Schuchat A, Robinson K, Wenger JD et al.: Bacterial meningitis in the United States in 1995. N Engl J Med 1997; 337: 970-976. 12) Perkins MD, Mirrett S, Reller LB: Rapid bacterial antigen detection in not clinically useful. J Clin Microbiol 1995; 33: 1486-1491. 13) Spinola SM, Sheaffer CI, Philbrick KB et al.: Antigenuria after Haemophilus influenzae type b polysaccharide immunization: A prospective study. J Pediatr 1986; 109: 835-838. 14) Rothstein EP, Madore Comparison of antigenuria with three Haemophilus gate vaccines. Pediatr Infect Dis J 1991; 10: 311-314. 20) Kristiansen B, Ask E, Jenkins A et al.: Rapid diagnosis of meningococcal meningitis by polym- erase chain reaction. Lancet 1991; 337:

Twenty-eight cases of bacterial meningitis during the recent ten years were analyzed retrospectively, and the following results were obtained. 1. Pathogens were as follows; H. influenzae 13 (46.4%), S. pneumoniae 8 (28.6%), S. agalactiae 4 (14.3%), E. coli 2 (7.1%), and L. monocytogenes 1 case (3.6%). 2. Twelve out of the thirteen H. influenzae cases were caused by serotype b (Hib), and 2 strains were Ĉ-lactamase producer. Fifty percent of the S. pneumoniae cases were caused by penicillinresistant strains. And all these resistant strains belonged to serotype 19 or 23. 3. Underlying diseases related to the onset of meningitis were found in 46% of the cases, and these consisted of CNS shunt operated 5, asplenia or polysplenia 2, Mondinrs anomaly 1, sacral dermal sinus 1, and neonate 4 cases. complete 4. Prognosis of these cases were three deaths, four with neurologic sequelae, and twenty-one recoveries. 5. On admission, 85% (17/20) of the cases were diagnosed correctly by the rapid antigen detection. Sensitivity and specificity of the rapid antigen detection by using latex particle agglutination is 90% and 100% in the Hib cases, and 83% and 100% in the S. pneumoniae cases respectively. Moreover, the bacteriologically unknown 2 cases caused by parenteral partial treatment were also diagnosed by the detection of antigen in concentrated urine.

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