THESES

POSTMENINGITIC BACTERIAL HYDROCEPHALUS IN INFANCY: REPORT OF 23 CASES AND REVIEW OF THE LITERATURE (ABSTRACT)^* * Hidrocefalia pós-meningite bacteriana na infância: análise de 23 casos e revisão da literatura (Resumo). Dissertação de Mestrado, Universidade de São Paulo (Área: Neurologia). Orientador: José Paulo Smith Nóbrega. . DISSERTATION. SÃO PAULO, 2002.

PAULO MANABU HONDA^** * Hidrocefalia pós-meningite bacteriana na infância: análise de 23 casos e revisão da literatura (Resumo). Dissertação de Mestrado, Universidade de São Paulo (Área: Neurologia). Orientador: José Paulo Smith Nóbrega.

Despite hydrocephalus being a frequent bacterial meningitis complication , there are few reports pertaining to this subject in the literature. In fact, we found only 13 reports which included this etiological description.

In the current work we present 23 new cases, 20 of which include etiological agent descriptions. All subjects were under 5 years old and treated at the Institut of Infectology Emilio Ribas (IIER) between 01/01/95 and 12/31/99. They were predominantly male (14 patients or 60.9%), the majority being 12 months of age or under (18 patients or 78.3%). Thirteen cases aged six months or under.

The etiological agents were as follows: Streptococcus pneumoniae (eight patients), Haemophillus influenzae (six patients), Neisseria meningitidis (three patients), group B Streptococcus (two patients) and Salmonella sp (one patient). The causative organism was not found in three patients.

The incidence of postmeningitic bacterial hydrocephalus throughout the IIER 5 year study , varied according to age. In children up to 4 years old , the incidence over the 5 year period averaged 2.9%, whereas between 0 and 12 months it was 3.57% and in the range 0 to 6 months it was 7.69%.

We had other tomographic findings, caused by meningitis, in 17 patients (74%). The major finding was that of ischemic infarts, present in 10 patients (43.5%), and associated with S. pneumoniae in six patients.

We treated 22 patients with ventriculoperitoneal shunts. One patient had an arrested hydrocephalus and required only transient external ventricular drainage. Owing to complications we revised the shunt systems of four patients (18.2%) and had infection in another three patients (13.6%). Subsequently, one of these three patients died. We did 12 months of follow-up on 16 patients, after which only three remained with no neurological symptoms.

We concluded that postmeningitic hydrocephalus is a very important complication of bacterial meningitis, mainly in patients under 6 months old, and that its morbidity is higher when associated with S. pneumoniae etiology.

KEY WORDS: hydrocephalus, acquired hydrocephalus, bacterial meningitis, meningitis complications, Streptococcus pneumoniae.

** Adress: Avenida Angélica 2635 / 132, 01227-200 São Paulo SP, Brasil. E-mail: phdhonda@uol.com.br

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