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Adverse outcomes of bacterial meningitis in school-age survivors
K Grimwood1, V A Anderson, L Bond
1Department of Paediatrics and Clinical Epidemiology, University of Melbourne, Victoria, Australia.
Insights
School-age survivors of bacterial meningitis face increased risks for cognitive, behavioral, and auditory deficits. These long-term outcomes, including major disabilities in 8.5% of survivors, highlight the need for ongoing medical and educational support.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Bacterial meningitis is a serious infection with potential long-term consequences.
- Understanding the sequelae in school-age survivors is crucial for effective management and support.
Purpose of the Study:
- To evaluate the neurologic, neuropsychologic, behavioral, and academic outcomes in school-age survivors of bacterial meningitis.
- To compare outcomes of survivors with age- and sex-matched control children.
Main Methods:
- A prospective cohort study enrolled 158 children (3 months to 14 years) treated for meningitis between 1983-1986.
- A follow-up evaluation of 130 survivors (82% of cohort) was conducted between 1991-1993, with blinded assessments of neurologic, neuropsychologic, audiologic, and behavioral functions.
- Multivariate analyses adjusted for age and socio-demographic variables.
Main Results:
- Meningitis survivors showed significantly poorer outcomes in fine motor function, IQ scores, school behavior, neuropsychologic function, and auditory figure-ground differentiation compared to controls.
- Major deficits (IQ < 70, seizures, hydrocephalus, spasticity, blindness, or severe hearing loss) were observed in 8.5% of survivors.
- Overall, 26.9% of meningitis survivors experienced some form of disability, with those having acute neurologic complications facing higher risks.
Conclusions:
- Approximately one in four school-age meningitis survivors experiences significant sequelae, including disabling conditions or functional impairments affecting academic performance.
- Survivors, as a group, exhibit poorer overall functioning compared to their peers, with heightened risk for those with prior acute neurologic complications.
- Continuous follow-up is recommended for all meningitis survivors, particularly until they reach school age, to monitor and manage long-term effects.
Objective:
To determine the outcomes of bacterial meningitis in school-age survivors.
Design:
Prospective cohort study.
Setting:
Teaching pediatric hospital.
Children:
During 1983 through 1986, 158 meningitis survivors, ages 3 months to 14 years, treated at a single center were enrolled. Between 1991 and 1993, 130 children, 82% of the original cohort, were evaluated at a mean age of 8.4 years and a mean of 6.7 years after their meningitis.
Outcome Measures:
Blinded neurologic, neuropsychologic, audiologic, behavior, and socio-demographic assessments were compared with those from grade- and sex-matched control children. Multivariate analyses adjusted for age at testing and socio-demographic variables.
Results:
There was a systematic increase in risk of abnormality or poorer functioning for children with meningitis, compared with control children, across all categories tested, which was significant for fine motor function, Intelligence quotient (IQ) scores, and tests of school behavior, neuropsychologic function, and auditory figure-ground differentiation. Eleven children who had experienced meningitis (8.5%) had major deficits (IQ < 70, seizures, hydrocephalus, spasticity, blindness, or severe to profound hearing loss); a further 24 (18.5%) cases and 14 (10.8%) control children had minor deficits (IQ 70 to 80, inability to read, mild to moderate hearing loss, abnormalities in speech discrimination, or school behavior problems). Overall, children who had meningitis were at greater risk (26.9%) for disability. Children with acute neurologic complications had more adverse outcomes than those with uncomplicated meningitis and control children (39% vs 18% vs 11%, respectively).
Conclusions:
One in four school-age meningitis survivors has either serious and disabling sequelae or a functionally important behavior disorder, neuropsychologic or auditory dysfunction adversely affecting academic performance. As a group, survivors function less well than their classroom peers, and risk is greatest for, but not confined to, those who had acute neurologic complications. All survivors require careful follow-up, at least until school age.