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Pneumococcal meningitis. Late neurologic sequelae and features of prognostic impact
Abstract:
We interviewed and neurologically reexamined 94 patients who had previous pneumococcal meningitis. The findings were allocated into groups with and without a causal relationship to the meningitis. The main sequelae after meningitis were dizziness (23%), tiredness (22%), mild memory deficits (21%), and gait ataxia (18%), whereas other focal neurologic signs were rare. By a rating (0 to 5) of the presence and severity of sequelae after meningitis, 54% of the patients were found to have sequelae. The clinical condition at the time of acute illness was studied in subgroups of patients who had different neurologic sequelae or high sequelae ratings. Gait ataxia was associated with a state of agitation and confusion when the patient was admitted for meningitis. High sequelae ratings on reexamination were associated with an affected consciousness at the acute stage of the disease and with high numbers of WBCs in the CSF at the time of hospitalization.
Insights
Pneumococcal meningitis can lead to lasting neurological issues, including dizziness and memory problems, in over half of patients. Early confusion and high white blood cell counts in cerebrospinal fluid predict severe long-term sequelae.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Pneumococcal meningitis is a serious infection with potential long-term neurological consequences.
- Understanding the prevalence and predictors of these sequelae is crucial for patient management and prognosis.
Purpose of the Study:
- To investigate the neurological sequelae in patients following pneumococcal meningitis.
- To identify clinical factors associated with the presence and severity of these long-term effects.
Main Methods:
- Neurological reexamination of 94 patients with a history of pneumococcal meningitis.
- Assessment and rating of sequelae severity (0-5 scale).
- Correlation of sequelae with acute illness clinical presentation and cerebrospinal fluid (CSF) parameters.
Main Results:
- 54% of patients exhibited neurological sequelae, with dizziness (23%), tiredness (22%), mild memory deficits (21%), and gait ataxia (18%) being most common.
- Gait ataxia was linked to agitation and confusion during acute illness admission.
- Severe sequelae correlated with impaired consciousness and elevated white blood cell (WBC) counts in CSF during hospitalization.
Conclusions:
- Neurological sequelae are common after pneumococcal meningitis, impacting a significant portion of survivors.
- Clinical indicators during acute infection, such as altered consciousness and CSF WBC count, can predict the likelihood and severity of long-term neurological deficits.