427 - Pediatric Meningitis in the Dominican Republic: A Ten-Year Review of Clinical and Therapeutic Trends

Publication Number: 2415.427

Angelica Montilla, Boston Medical Center, Boston, MA, United States; Danilo Peralta, Hospital General De la Plaza de la Salud, Santo Domingo, Distrito Nacional, Dominican Republic; Sayira Mueses, Universidad Iberoamericana, Santo Domingo, Distrito Nacional, Dominican Republic; Maria Gomez, Hospital General de la Plaza de la Salud, Santo Domingo, Distrito Nacional, Dominican Republic; Dolores Mejia, Hospital General de la Plaza de la Salud, Santo Domingo, Distrito Nacional, Dominican Republic; Alcy Torres, Boston University School of Medicine, Boston, MA, United States

Background: Pediatric meningitis requires rapid diagnosis and treatment to prevent serious complications (epilepsy, developmental delay, death); prior national data in the Dominican Republic report a 7.83% fatality rate. Management is complicated by healthcare and socioeconomic resource constraints.

Objective: To describe 10-year clinical, microbiological, and therapeutic trends in pediatric meningitis in the Dominican Republic and identify implications for practice and prevention.

Design/Methods: Retrospective descriptive review of 134 pediatric patients (>2 months–14 years) diagnosed with meningitis at a single hospital (2010–2020). Medical records were abstracted for demographics, presentation, etiology, treatments, and outcomes. Data were summarized with frequencies/percentages; group comparisons used Chi-square tests.

Results: Females comprised 51.5% (69/134); the most affected age group was 1–4 years (38.1%; 51/134). Bacterial meningitis accounted for 53.0% (71/134); among culture-positive cases, Streptococcus pneumoniae predominated (21.4%; 9/42). Fever was the most common symptom (90.3%; 121/134), while neck stiffness was present in only 38.8% (52/134). Third-/fourth-generation cephalosporins were used in 86.6% (116/134). Corticosteroids were given empirically in 58.2% (78/134); 35.1% (47/134) received them as adjuvant therapy during etiologic treatment. Among patients with complete follow-up who received etiologic-phase corticosteroids (n=44), 36.4% (16/44) developed sequelae. The most common sequelae was headache (18.2%; 8/44), followed by delayed motor (9.1%; 4/44) and psychological development (6.8%; 3/44). Prior illness/history was documented in 64.0% (91/134), most frequently upper respiratory infections (36.2%; 33/91) and CNS malformations (26.3%; 24/91).

Conclusion(s): Streptococcus pneumoniae emerged as the predominant pathogen in this cohort. The absence of classic meningeal signs should not preclude the diagnosis of meningitis. Respiratory infections appeared to be significant predisposing factors. Although cephalosporins remain the mainstay of treatment, variability in corticosteroid use highlights differences in clinical practice and ongoing uncertainty regarding their therapeutic benefit. Given that over one-third of patients receiving corticosteroids developed neurological sequelae, further investigation is warranted to elucidate their true impact on outcomes.

Demographic and clinical characteristics of children with meningitis treated at a tertiary care hospital in the Dominican Republic, 2010–2020
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