scholarly journals Bacterial Meningitis in Children: Neurological Complications, Associated Risk Factors, and Prevention

2021 ◽  
Vol 9 (3) ◽  
pp. 535 ◽  
Author(s):  
Abdulwahed Zainel ◽  
Hana Mitchell ◽  
Manish Sadarangani
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Neuronal Damage ◽  
Case Fatality ◽  
Neurological Complications ◽  
Bacterial Toxin ◽  
Haemophilus Influenzae Type ◽  
Subdural Effusion ◽  
Delayed Presentation ◽  
Increased Risk

Bacterial meningitis is a devastating infection, with a case fatality rate of up to 30% and 50% of survivors developing neurological complications. These include short-term complications such as focal neurological deficit and subdural effusion, and long-term complications such as hearing loss, seizures, cognitive impairment and hydrocephalus. Complications develop due to bacterial toxin release and the host immune response, which lead to neuronal damage. Factors associated with increased risk of developing neurological complications include young age, delayed presentation and Streptococcus pneumoniae as an etiologic agent. Vaccination is the primary method of preventing bacterial meningitis and therefore its complications. There are three vaccine preventable causes: Haemophilus influenzae type b (Hib), S. pneumoniae, and Neisseria meningitidis. Starting antibiotics without delay is also critical to reduce the risk of neurological complications. Additionally, early adjuvant corticosteroid use in Hib meningitis reduces the risk of hearing loss and severe neurological complications.

scholarly journals Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

2001 ◽  
Vol 35 (3) ◽  
pp. 249-255 ◽  
Author(s):  
Débora PL Weiss ◽  
Paul Coplan ◽  
Harry Guess
Keyword(s):  
Bacterial Meningitis ◽  
Western Europe ◽  
Average Length ◽  
Case Fatality ◽  
Antibiotic Use ◽  
Health Department ◽  
Population Based ◽  
Haemophilus Influenzae Type ◽  
Average Length Of Stay ◽  
Meningitis In Children

OBJECTIVE: To document the incidence and the descriptive epidemiology of bacterial meningitis among individuals under age 20 in a geographically defined region in Brazil during the two-year period immediately preceding the introduction of Haemophilus influenzae type b (Hib) vaccines into the national immunization program of Brazil. METHODS: Population-based epidemiological study of all cases of bacterial meningitis reported among residents of Campinas, Brazil, under age 20 (n=316,570) during the period of 1997-98, using comprehensive surveillance records compiled by the Campinas Health Department from cases reported among hospital inpatients, outpatients, emergency room visits, death certificates, and autopsy reports. RESULTS: The incidence of bacterial meningitis (n=274) was 334.9, 115 and 43.5 cases/10(5) person-years (pys) for residents of Campinas under age 1, 5 and 20, respectively. All cases were hospitalized, with an average length of stay of 12 days. Documented prior antibiotic use was 4.0%. The case-fatality rate of bacterial meningitis in individuals under age 20 was 9% (24/274) with 75% of deaths occurring in children under the age of five. The incidence of Hib meningitis (n=26) was 62.8 and 17 cases/10(5) pys in children age <1 and <5, respectively. CONCLUSIONS: The incidence of Hib meningitis in children under the age of 5 in Campinas during 1997-98 was similar to that reported in the US, Western Europe, and Israel prior to widespread Hib vaccine use in those regions. This study provides a baseline for later studies to evaluate changes in the etiology and incidence of bacterial meningitis in children after introduction of routine Hib vaccination in Brazil.

Sequelae of Acute Bacterial Meningitis in Children Treated for Seven Days

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 21-25
Author(s):  
T. Jadavji ◽  
W. D. Biggar ◽  
R. Gold ◽  
C. G. Prober
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Haemophilus Influenzae Type ◽  
Acute Bacterial Meningitis ◽  
Haemophilus Influenzae Type B ◽  
Type B ◽  
Speech Defect ◽  
Intravenous Antibiotic ◽  
Severe Handicaps ◽  
Meningitis In Children

The sequelae of acute bacterial meningitis in children who were treated with ampicillin or chloramphenicol for seven days during the period January 1979 to June 1983 were assessed prospectively. The 235 patients (117 boys and 118 girls) ranged in age from four days to 18 years (mean 26.4 months). Haemophilus influenzae type b was isolated in 70% of patients, Streptococcus pneumoniae in 20%, and Neisseria meningitidis in 10%. The mortality rate was 6.4%. No relapses occurred. Of the 220 survivors, 171 had neurologic psychometric, audiologic, and ophthalmologic assessments performed for a minimum of 1 year following their illness. One hundred thirty-six (80%) children had no detectable sequelae; 20% had mild to severe handicaps. The frequency of sequelae was greatest among children with S pneumoniae meningitis (57%) and least among children with N meningitidis (0%). The sequelae observed included: sensorineural hearing loss (12.9%), developmental delay (5.3%), speech defect (4.7%), motor defect (3.0%), hydrocephalus (1.7%), and seizure disorder (1%). The frequency of observed sequelae among these patients is similar to that previously reported in children treated for ten to 14 days. Our findings indicate that seven days of intravenous antibiotic therapy is adequate for the treatment of bacterial meningitis in children.

scholarly journals Clinical Profile and Outcome of Acute Encephalitis Syndrome in Dhulikhel Hospital of Nepal

2013 ◽  
Vol 32 (3) ◽  
pp. 201-205 ◽  
Author(s):  
Srijana Dongol ◽  
Shreema Shrestha ◽  
Narayan Shrestha ◽  
J Adhikari
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Sensorineural Hearing Loss ◽  
Clinical Signs ◽  
Viral Meningitis ◽  
Sensorineural Hearing ◽  
Subdural Effusion ◽  
Eosinophilic Meningitis ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis

Introduction: Acute encephalitis syndrome (AES) is a constellation of clinical signs and or symptoms i.e. acute fever with acute change in mental status. AES may be present as encephalitis, meningoencephalitis or meningitis. It can be associated with severe complication, including impaired consciousness, seizure, limb paresis or death. Materials and Methods: Study consisted of retrospective analysis of hospital records of children up to 16 years of age admitted with diagnosis of AES in the department of Paediatrics Dhulikhel Hospital, Kathmandu University Teaching Hospital, Dhulikhel Kavre from January 2010 to December 2011. Results: During the two years (January 2010 to December 2011), 47 patients of AES were admitted. Among the admitted cases there were 34 male and 13 female patients. Meningitis cases were 29, encephalitis cases were 14 and 4 meningoencephalitis cases. Among the meningitis cases, viral meningitis accounted for 12, bacterial meningitis accounted for 15 and 1 tubercular meningitis.One was eosinopilic meningitis in which the causative organism was found to be fasciolosis by ELISA. Viral encephalitis was found to be the most common cause of encephalitis. Sensorineural hearing loss was seen in 3 cases, subdural effusion in 1 and hydrocephalus in 1. One patient had intracranial hemorrhage with hemiparesis as a complication of eosinophilic meningitis. Conclusion: Acute encephalitis syndrome is one of the most common causes of PICU admission in Dhulikhel hospital. Bacterial meningitis was common among the acute encephalitis syndrome followed by viral meningitis. One case of eosinophilic meningitis with intracranical hemorrhage and hemiparesis was found. Sensorineural hearing loss was found to be commonest complication. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6683 J. Nepal Paediatr. SocVol.32(3) 2012 201-205

Sensorineural hearing loss after bacterial meningitis in children residing in Nur-Sultan

2020 ◽  
Vol 18 (4) ◽  
pp. 189-194
Author(s):  
A. Seidullayeva ◽  
◽  
D. Bayesheva ◽  
B. Turdalina ◽  
A. Altynbekova ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Sensorineural Hearing Loss ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
Clinical Manifestations ◽  
Otoacoustic Emission ◽  
Neurological Complications ◽  
Viral Meningitis ◽  
Sensorineural Hearing

Bacterial meningitis (BM) is a widespread health problem characterized by severe clinical manifestations and high incidence of neurological complications. BM remains one of the main causes of disability and mortality among young children all over the world. Hearing loss is one of neurological complications associated with BM. It accounts for up to 60%–90% of all cases of acquired sensorineural hearing loss (SNHL). Between 2015 and 2018, we performed screening for SNHL among children who had had BM. Seven out of 62 patients examined (11.3%) were found to have SNHL. BM was primarily caused by Streptococcus pneumoniae (n = 4) and Neisseria meningitidis (n = 3). Three out of 4 patients had grade 3–4 SNHL. Computed tomography revealed cochlear ossification in two children and cochlear fibrosis in one child (who had successful cochlear implantation later). For the rest of the patients, we recommended hearing aids. We also found that hearing loss usually develops after BM and does not affect patients with viral meningitis (caused by enteroviruses). We recommend that children with BM undergo regular screening for SNHL (every 3 days during treatment) using otoacoustic emission. These patients should be also examined by an audiologist after discharge from hospital and then every three months for a year. Key words: children, cochlear implantation, meningitis, sensorineural hearing loss, acquired deafness

scholarly journals Initial Therapy of Bacterial Meningitis with Cefuroxime: Experience in 167 Children

1992 ◽  
Vol 3 (4) ◽  
pp. 162-166
Author(s):  
Lissette Navas ◽  
Susan M King ◽  
Ronald Gold
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Case Fatality Rate ◽  
Chart Review ◽  
Case Fatality ◽  
Retrospective Chart Review ◽  
Initial Therapy ◽  
Fatality Rate ◽  
Sick Children ◽  
Previous Prospective Study

The morbidity and mortality of patients with bacterial meningitis treated initially with cefuroxime were studied and compared with the results of a previous prospective study of patients treated initially with ampicillin plus chloramphenicol in the same institution from 1979 to 1983. A retrospective chart review was completed in all cases of microbiologically confirmed bacterial meningitis admitted to the Hospital for Sick Children in Toronto, Ontario between January 1, 1984 and August 1, 1988. During this period all patients were treated initially with intravenous cefuroxime. The 167 children reviewed ranged in age from six weeks to 17.1 years (median 11.6 months). The case fatality rate was 7.8% and the rate of hearing deficit 13%. There were no statistically significant differences in abnormal neurological outcome (20 versus 20%, respectively), hearing loss (12.9 versus 13%, respectively), and case fatality rate (6.4 versus 7.8%, respectively) between the cohort of 1979–83 and the present study. The rate of hearing loss following meningitis caused byHaemophilus influenzaetype b increased from 7.3 to 11.7% (P=0.26).

scholarly journals CSF Neurofilament Light Chain Concentrations Predict Outcome in Bacterial Meningitis

2021 ◽  
Vol 9 (1) ◽  
pp. e1123
Author(s):  
Nora Chekrouni ◽  
Thijs M. van Soest ◽  
Matthijs C. Brouwer ◽  
Eline A.J. Willemse ◽  
Charlotte E. Teunissen ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Light Chain ◽  
Neuronal Damage ◽  
Area Under The Curve ◽  
Case Fatality ◽  
High Serum ◽  
Unfavorable Outcome ◽  
Index Test ◽  
Neurofilament Light Chain ◽  
Neurofilament Light

Background and ObjectivesNeurofilament light chain (NfL) is a biomarker for neuroaxonal damage and has been found to be elevated proportionally to the degree of neuronal damage in neurologic diseases. The objective of this study was to determine the prognostic accuracy of NfL concentrations on unfavorable outcome in adults with community-acquired bacterial meningitis.MethodsWe measured NfL concentration CSF samples from a prospective cohort study of adults with community-acquired bacterial meningitis in The Netherlands and determined associations between NfL CSF concentrations, clinical characteristics, and outcome in multivariate analyses. We identified independent predictors of an unfavorable outcome (Glasgow Outcome Scale scores 1–4) by logistic regression.ResultsCSF NfL concentrations were evaluated in 429 episodes of 425 patients with community-acquired bacterial meningitis. The median age of 429 episodes was 62 years (interquartile range, 50–69 years). Of note, 290 of 422 (68%) episodes presented with an altered mental status (Glasgow Coma Scale score < 14). Most common causative pathogens were Streptococcus pneumoniae (73%), Neisseria meningitidis (7%), and Listeria monocytogenes (5%). The overall case fatality rate was 62 of 429 (15%), and unfavorable outcome occurred in 57 (37%) of 429 episodes. In multivariate analysis, predictors of unfavorable outcome were older age (OR 1.03, 95% CI 1.01–1.05), cranial nerve palsy (OR 4, 95% CI 1.6–10.3), high serum C-reactive protein concentration (OR 1.3, 95% CI 1.01–1.05), and high CSF NfL concentration (OR 1.5, 95% CI 1.07–2.00). CSF NfL concentrations were higher in patients presenting with focal cerebral deficits (717 pg/mL [416–1,401] vs 412 pg/mL [278–731]; p < 0.001). The area under the curve (AUC) for predicting unfavorable outcome in bacterial meningitis of CSF NfL concentration was 0.69 (95% CI, 0.64–0.74).DiscussionCSF NfL concentration is independently associated with unfavorable outcome in adults with community-acquired bacterial meningitis, suggesting that CSF NfL concentration may be a useful biomarker for prognostic assessment in bacterial meningitis.Classification of EvidenceCan the level of NfL in CSF (the index test) predict unfavorable outcome in patients with bacterial meningitis, in a cohort of bacterial meningitis patients with a favorable and unfavorable outcome? This study provides Class II evidence that NfL level in CSF is a moderate predictor, with the AUC for predicting unfavorable outcome in bacterial meningitis being 0.69 (95% CI, 0.64–0.74).

#22: Trends in Bacterial Meningitis in a Tertiary-Level Children′s Hospital in Mexico, Following Haemophilus influenzae and Streptococcus pneumoniae Vaccination (1990–2018)

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S15
Author(s):  
X León-Lara ◽  
I Medina-Vera ◽  
E Arias de la Garza ◽  
M Macías-Parra
Keyword(s):  
Risk Factors ◽  
Bacterial Meningitis ◽  
Haemophilus Influenzae ◽  
Conjugate Vaccine ◽  
Pediatric Patients ◽  
Neurological Complications ◽  
Morbidity And Mortality ◽  
World Health ◽  
Haemophilus Influenzae Type ◽  
Conjugate Vaccines

Abstract Background Bacterial meningitis (BM) remains a significant global health problem in pediatric care, with substantial morbidity and mortality. The epidemiology of BM has changed over the last 20 years. The ongoing introduction of conjugate vaccines for the most common meningeal pathogens has reduced the global incidence. However, there is limited epidemiologic and microbiologic data of BM in children before and after the widespread use of these vaccines in Mexico. Methods We conducted a retrospective, observational, analytical study. Pediatric patients (from 1 month to 18 years of age) presenting with BM and hospitalized at the Instituto Nacional de Pediatria in Mexico City, from 1990 to 2018, were included. Meningitis from invasive procedures or complicated head trauma were excluded. BM was classified according to the World Health Organization (WHO) criteria. The cases were analyzed in three periods: period A (1990–1999), period B (2000–2008), and period C (2009–2018). Period A corresponds to the time before the conjugate Haemophilus influenzae type b (Hib vaccine) was introduced in Mexico, while periods B and C correspond to the time after the Hib vaccine was routinely applied. Periods A and B correspond to the period before the pneumococcal conjugate vaccine (PCV7) was administrated in Mexico, while period C is after PCV7 and PCV13 were routinely administrated. The proportion of cases between periods was compared with Chi-square or Fisher exact test; P &lt; 0.05 was considered significant. Binomial logistic regression analysis was used to determine the association between potential risk factors and death due to BM. Results A total of 226 cases with BM were included, 180 (79.6%) confirmed cases, and 46 (20.4%) probable cases. The median age at diagnosis was 10 months. There were 126 (55.8%) cases in Period A, 62 (27.4%) cases in Period B, and 38 (16.8%) cases in Period C, with a statistically significant reduction between periods (P = 0.0001). Hib was the most commonly isolated pathogen, found in 38 (50%) cases. However, its proportion declined significantly after the introduction of the Hib conjugate vaccine (P &lt; 0.0001). S. pneumoniae followed as the second most commonly isolated bacterial pathogen. There was a significant reduction in neurological complications after the Hib conjugate vaccine (P = 0.003) and the S. pneumoniae conjugate vaccine (P = 0. 05) were introduced. Independent risk factors associated with mortality were coma (OR 15, P = 0. 0001), intracerebral bleeding (OR 3.5, P = 0.046), and pneumococcal meningitis (OR 9.4, P = 0. 002). Conclusions BM remains a cause of morbidity and mortality in pediatric patients in this hospital, with a dramatic change in the epidemiology since the introduction of the Hib conjugate vaccine to the national immunization schedule. Routine use of childhood conjugate vaccines against the most frequent etiological agents reduced the number of cases globally, mainly those caused by Hib. Additionally, conjugate vaccines reduced neurological complications and sequelae caused by this disease.

Dexamethasone Therapy for Children With Bacterial Meningitis

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Ellen R. Wald ◽  
Sheldon L. Kaplan ◽  
Edward O. Mason ◽  
Diane Sabo ◽  
Lawrence Ross Md ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Los Angeles ◽  
Bacterial Meningitis ◽  
Auditory Brainstem Responses ◽  
Haemophilus Influenzae Type ◽  
Controlled Clinical Trial ◽  
Developmental Outcome ◽  
Severe Hearing Loss ◽  
Significant Difference ◽  
Neurologic Sequelae

Objective. To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae. Design. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year. Setting. The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio. Patients. Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year. Interventions. Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission. Main outcome measures. Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later. Main results. One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups. Conclusion. All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.

scholarly journals The epidemiology of bacterial meningitis in Kosovo

2014 ◽  
Vol 8 (07) ◽  
pp. 823-830 ◽  
Author(s):  
Sadie Avdiu Namani ◽  
Remzie A Koci ◽  
Emine Qehaja-Buçaj ◽  
Lindita Ajazaj-Berisha ◽  
Murat Mehmeti
Keyword(s):  
Bacterial Meningitis ◽  
Case Fatality Rate ◽  
Pediatric Population ◽  
Case Fatality ◽  
Neurological Complications ◽  
Clinical Center ◽  
Post War ◽  
The University ◽  
Epidemiologic Features ◽  
New Vaccines

Introduction: The purpose of this study was to present the epidemiologic features of bacterial meningitis in the developing country of Kosovo. Methodology: Data were collected from active surveillance of bacterial meningitis cases treated at the University Clinical Center of Kosovo in the years 2000 (first post-war year) and 2010. Results: Meningitis cases in 2000 compared with 2010 showed a 35.5% decline in incidence (from 4.8 to 3.1 cases per 100,000 population) and a decrease in the case fatality rate from 10% to 5%. In children, there was a lower mortality rate (5% versus 2%) and a lower incidence of neurological complications (13% versus 16%) as compared to adults (32% versus 10% and 16% versus 35%, respectively). Neisseria meningitidis was the most common pathogen of bacterial meningitis in both study periods. Bacterial meningitis was most prevalent in the pediatric population, and showed an increase in the median age, from three years in 2000 to seven years in 2010. A steady number of bacterial meningitis cases in adults throughout last decade (around 20 cases per year) was recorded. Conclusions: During the last decade, gradual changes have been observed in the epidemiology of bacterial meningitis that are unrelated to the introduction of new vaccines, but are partly due to the improvement of living conditions.

Subdural Effusion and Its Relationship With Neurologic Sequelae of Bacterial Meningitis in Infancy: A Prospective Study

PEDIATRICS ◽  
1990 ◽  
Vol 86 (2) ◽  
pp. 163-170
Author(s):  
Jeffrey D. Snedeker ◽  
Sheldon L. Kaplan ◽  
Philip R. Dodge ◽  
Sandra J. Holmes ◽  
Ralph D. Feigin
Keyword(s):  
Bacterial Meningitis ◽  
Rapid Onset ◽  
Haemophilus Influenzae Type ◽  
Acute Bacterial Meningitis ◽  
Subdural Effusion ◽  
Bacterial Antigen ◽  
Neurologic Sequelae ◽  
Long Term Follow Up ◽  
A Prospective Study

One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on long-term follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.

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