Clinical features to distinguish meningitis among young infants at a rural Kenyan hospital

Detection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middle-income countries most health facilities lack laboratory capacity and rely on clinical features to empirically treat meningitis. We conducted a diagnostic validation study to investigate the performance of clinical features (fever, convulsions, irritability, bulging fontanel and temperature =39°C) and WHO-recommended signs (drowsiness, lethargy, unconsciousness, convulsions, bulging fontanel, irritability or a high-pitched cry) in discriminating meningitis in young infants. Design Retrospective cohort study. Setting Kilifi County Hospital. Patients Infants aged <60 days hospitalised between 2012 and 2016. Main outcome measure Definite meningitis defined as positive cerebrospinal fluid (CSF) culture, microscopy or antigen test, or leucocytes =0.05 x 10a 9/L. Results Of 4809 infants aged