Neonatal meningitis: Diagnostic and therapeutic challenges

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Published Sep 13, 2026
https://doi.org/10.62438/tunismed.v104i08.6280
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Vol. 104 No. 08 (2026): Tunis Med Aug 2026

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Imen Bel Hadj
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia
Meriem Mediouni
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia
Emna Trabelsi
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia
Amine Meddeb
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia
Fatma Khalsi
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia
Hanène Smaoui
Department of Microbiology, Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar,1007, Tunis, Tunisia
Ines Trabelsi
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia
Khadija Boussetta
Department of Pediatric Medicine "B", Bechir Hamza Children's Hospital, Tunis, Faculty of Medecine, University of Tunis El Manar, 1007, Tunis, Tunisia

Abstract

Aim: To describe the clinical, biological, microbiological, and radiological aspects of neonatal meningitis (NNM) as well as its treatment and outcome and to compare between bacterial NNM and viral NNM.
Methods: A Retrospective study of NNM cases, conducted at Pediatric Medicine B department of Bechir Hamza Children’s Hospital over a 15-year period (2004-2018).
Results: Forty-seven newborns with meningitis were included. The average age was 15 days (range: 0,62–27 days). The main reasons for consultation were fever (81%), seizures (13%), poor feeding (15%) and digestive symptoms (15%). Physical examination revealed axial hypotonia (26%) and bulging anterior fontanel (4%).
The C-reactive protein level was elevated in 32% of cases with a mean value of 81.5 mg/L. A C-reactive protein value greater than 50 mg/L was statistically associated with bacterial NNM (p<0.001). The analysis of clinical and microbiological data identified 26 cases (55%) of bacterial NNM and 21 cases (45%) of viral NNM. Polymerase chain reaction detected enterovirus genome in two cases. Bacterial NNM were complicated by hydrocephalus (n=3) and ventriculitis (n=4). Compared to the viral NNM group, the bacterial NNM group had a significantly lower mean age (p=0.02), while prematurity, axial hypotonia and grunting were significantly more frequent (p<0.05).
Conclusions: Viral NNM are generally benign and rarely require a specific treatment, but they are often underdiagnosed due to the lack of systematic Polymerase Chain Reaction testing in our country. Bacterial NNM are more severe, may lead to neurological sequelae, and are rarely well documented.

Keywords:

Newborn, Meningitis, Cerebrospinal fluid, Antibiotherapy

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