Influence of malnutrition on the course of childhood bacterial meningitis.

BACKGROUND Malnutrition may be an important cofactor explaining poor outcome of childhood bacterial meningitis (BM) in developing countries. We examined its effect in Latin American children. METHODS The weight-for-age z score was determined for 482 children with BM aged 2 months to 5 years. Normal weight (z score from >-1 to <+1), underweight (z score <-1) and overweight (z score >+1) children were compared on admission, in-hospital and at discharge. Using uni- and multivariate analysis, we sought for associations between malnutrition and 3 different outcomes. RESULTS The mean z score was -0.41 +/- 1.54, with a normal distribution. Overall, 260 (54%) patients were of normal weight, 151 (31%) underweight, and 71 (15%) overweight. Compared with others, underweight patients had on admission a lower Glasgow coma score (P = 0.0006) and cerebrospinal fluid glucose concentration (P = 0.03), and a slower capillary filling time (P = 0.02). Their death rate was higher (P = 0.0004) and they survived with more neurological sequelae (P = 0.04), but a similar frequency of hearing impairment (P > 0.05). The odds for death increased 1.98 times by mild (95% confidence interval [CI], 1.03-3.83; P = 0.04), 2.55 times by moderate (95% CI, 1.05-6.17; P = 0.04), and 5.85 times (95% CI, 2.53-13.50; P < 0.0001) by severe underweight. Overweight was not associated with adverse outcomes (P > 0.05). CONCLUSIONS Children who are underweight at the time of onset of BM have a substantially increased probability of neurological sequelae and death.