Acute central nervous system (CNS) infections in children can lead to neurological complications and mortality. This study aimed to identify the clinical manifestations, laboratory parameters, and cerebrospinal fluid characteristics indicative of CNS infections and define the risk factors that lead to pediatric intensive care unit (PICU) admission in the pediatric population of Şanlıurfa, a city in southeastern Turkey.

This retrospective analysis included patients aged 1 month to 18 years who were treated for acute CNS infections in the Şanlıurfa Training and Research Hospital between January 2020 and May 2023. Clinical data were obtained from the hospital electronic medical records.

A total of 68 patients with acute CNS infections were included in this study. The median patient age was 3 (0.94-8.75) years. Fever was the most prevalent symptom in 92.6% of the patients. Of the total, 25% (n = 17) of the patients had an identified causative agent and 35.3% (n = 24) were admitted to the PICU. Serum C-reactive protein (CRP) levels were significantly higher in patients with bacterial meningitis than in those with viral meningitis (p = 0.007). Patients with impaired consciousness and seizure were significantly more likely to require admission to the PICU than patients without these conditions (both p < 0.001). Patients requiring PICU admission had significantly higher platelet counts (p = 0.01).

Impaired consciousness, seizure, and thrombocytosis on admission were important risk factors for PICU admission. Serum CRP levels can serve as an indicator of bacterial meningitis. A combination of physical findings from clinical evaluations and laboratory data is necessary to accurately diagnose bacterial CNS infections.

Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.

Meningitis caused by bacteria, which is an inflammation of the meninges affecting the pia, arachnoid, and subarachnoid space, is still one of the leading causes of death and morbidity in infants and young children. Neisseria meningitidis, group B streptococcus (GBS), Haemophilus influenzae type B (Hib), Listeria monocytogenes, and Streptococcus pneumoniae have been found to be the most frequent causative agents. Infants and children can have modest, fluctuating, non-specific, or even absent clinical signs of bacterial meningitis. They may include bulging fontanelles, vomiting, diarrhea, respiratory distress, hypothermia, lethargy, irritability, poor feeding, and fever in babies. In this case report, an 18-month-old child presented to a local hospital with complaints of multiple episodes of high-grade fever. After 10 days, his symptoms worsened and he experienced two episodes of seizures at one-day intervals at night. He was taken to Acharya Vinoba Bhave Rural Hospital for further management. Blood investigations revealed seropositive results for dengue virus infection. On MRI and CT scan, it was diagnosed as an old case of subdural hematoma in the right frontotemporal region of the brain. The patient was on intravenous ceftriaxone and phenytoin. Gross motor developmental milestones in children with meningitis can be improved with early integrative neurophysiotherapy and a goal-oriented therapeutic regimen that includes mobility exercises, proprioceptive neuromuscular facilitation techniques, positioning, oromotor retraining, neurodevelopmental techniques, and balance and coordination retraining. A complex case presents with bacterial meningitis, hydrocephalus, and seizure disorder. The bacterial infection inflames the protective membranes of the brain, causing hydrocephalus. Increased cerebrospinal fluid puts pressure on the brain, leading to seizures. Managing these interconnected conditions requires a multidisciplinary approach making it unique, involving infectious disease, neurology, and neurosurgery expertise.