Neurological Complications in Young Infants With Acute Bacterial Meningitis

Abstract

We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1-173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7-13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35-27.0, P = 0.019) were independent predictors for final unfavorable outcomes. Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted.

Keywords: bacteremia; group B streptococcus; late-onset sepsis; meningitis; neurological complications.

Figure 1

MRI study of a 3 week old boy with GBS subdural empyema. Axial (A) and sagittal (B) T1-weighted gadolinium-enhanced MRI showed subdural empyema over bilateral frontal, parietal, occipital area (arrows); diffusion-weighted (C), and apparent diffusion coefficient (D)-weighted MRI of a subdural empyema over bilateral frontal, parietal, occipital area (arrows).

Figure 2

Time to diagnosis of various neurological complications in young infants with acute bacterial meningitis. Meningitis onset was defined as when the cerebrospinal fluid culture sampling was obtained, whereas onset of neurological complication was defined at the symptom presentation or diagnosis by neuroimaging studies.

Figure 3

MRI study of a 3 month old boy with GBS meningitis and infarction. (A) Axial T1-weighted gadolinium-enhanced MRI showed hyperintensity and (B) T2-weighted MRI showed hypointensity over left anterior frontal area (white arrows) and bilateral frontotemporal subdural effusion (white arrow head); The left anterior frontal lesion showed hyperintensity over diffusion-weighted (C) and hypointensity over apparent diffusion coefficient (D) weighted MRI which revealed recent infarction (white arrows).