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Neurological sequelae after childhood bacterial meningitis
Laura Lempinen1,2, Riste Saat3,4, Sakke Niemelä5
1HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, PB 340, 00029 HUS, Helsinki, Finland. laura.j.lempinen@hus.fi.
Insights
Childhood bacterial meningitis (BM) remains a significant threat, with notable rates of death and long-term neurological sequelae like aphasia/dysphasia. Despite advances, risk factors for these outcomes in BM survivors are not yet identified.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Bacterial meningitis (BM) continues to pose a significant risk of mortality and severe sequelae despite medical advancements.
- Streptococcus pneumoniae and Neisseria meningitidis are identified as the primary bacterial pathogens responsible for childhood BM.
Purpose of the Study:
- To evaluate the incidence, clinical presentation, pathogens, diagnostics, and outcomes of childhood bacterial meningitis.
- To assess neurological sequelae, hearing loss, and mortality rates associated with pediatric BM.
- To identify potential risk factors for death, unfavorable outcomes, and long-term neurological sequelae in children with BM.
Main Methods:
- A retrospective review of pediatric patients diagnosed with BM between 2010 and 2020 at a tertiary children's center.
- Utilized the Glasgow Outcome Scale (GOS) to classify outcomes, with scores 1-4 indicating an unfavorable outcome.
- Employed logistic regression univariate analysis to determine risk factors for adverse outcomes.
Main Results:
- The study included 74 patients (77 BM episodes) with an average BM incidence of 2.2/100,000/year, predominantly community-acquired (91%).
- Streptococcus pneumoniae and Neisseria meningitidis were the most common pathogens (16% each).
- Neurological sequelae were observed in 32% of survivors at long-term follow-up, with aphasia/dysphasia being most common (17%); 9% of patients died, and 3% experienced hearing loss.
Conclusions:
- Bacterial meningitis (BM) still carries a significant risk of mortality.
- A substantial proportion of BM survivors experience persistent neurological sequelae, particularly aphasia/dysphasia, and 3% develop hearing loss.
- No independent risk factors were identified for predicting long-term neurological sequelae in this cohort.
Abstract:
The purpose of this study is to evaluate childhood bacterial meningitis (BM): incidence, clinical presentation, causative pathogens, diagnostics, and outcome (neurological sequelae, hearing loss, and death). A retrospective review of all children aged ≤ 16 years and 1 month diagnosed with BM at a tertiary children's centre in the period 2010-2020. The Glasgow Outcome Scale (GOS) was used to assess outcome, with a GOS score of 1-4 considered to be an unfavourable outcome. Logistic regression univariate analysis was used to determine predefined risk factors for death, unfavourable outcome, and long-term neurological sequelae. Seventy-four patients (44 males) with a median age of 8.0 months (range 1 day to 16 years and 1 month) and 77 BM episodes were included in the study. The average incidence rate of BM was 2.2/100,000/year, the majority (91%) being community-acquired BM. Streptococcus pneumonia and Neisseria meningitidis were the most common pathogens 12/77 (16%) each. Neurological sequelae at discharge were present in 24 (34%) patients, unfavourable outcome in 19 (25%), and hearing loss (deafness) in two (3%) survivors of BM. Seven (9%) patients died. Long-term neurological sequelae were observed in 19/60 (32%), aphasia/dysphasia being the most common in 10 (17%) BM children. No independent risk factors were identified for long-term neurological sequelae in univariate analysis.
Conclusion:
The risk for a fatal course of BM is still remarkable. Neurological sequelae persisted in a substantial proportion of BM survivors in long-term follow-up, aphasia/dysphasia being the most common. Hearing loss (deafness) occurred in 3%. However, no specific risk factors predicting the long-term sequelae were found.
What Is Known:
• Streptococcus pneumonia and Neisseria meningitidis were the most common pathogens causing bacterial meningitis. • Risk for fatal course of bacterial meningitis (BM) remains remarkable despite advances in modern medicine.
What Is New:
• In long-term follow-up, 1/3 of BM children suffered from neurological sequelae in the 2010s, aphasia and dysphasia being the most common sequelae. • Hearing loss was diagnosed in only two (3%) children, whom of both were deaf.
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