Clinical blindness in conjunction with childhood bacterial meningitis

Abstract

Although rarely reported, bilateral loss of vision is a severe complication of childhood bacterial meningitis. We assessed its frequency in five prospective treatment trials performed in Europe, Latin America, and Angola in 1984-2017. Course of illness, follow-up findings, and child's sight were recorded. Sight was examined at discharge, and conditions permitting, also at 1-3 months post-hospitalization and in Angola on hospital day 7. Experienced pediatricians diagnosed clinical blindness if the child did not make eye contact, did not blink or move the eyes, or remained unresponsive to bright light or movement of large objects before their eyes. Of 1515 patients, 351, 654, and 510 were from Finland, Latin America, and Angola, respectively. At discharge, blindness was observed in 0 (0%), 8 (1.2%), and 51 (10%) children, respectively. In Angola, 64 children appeared to be blind on day 7; 16 of these children died. Blindness found at discharge in Angola was not invariably irreversible; approximately 40% had restored the sight at follow-up visit. Clinical blindness rarely occurred in isolation and was usually associated with young age and poor general condition at hospital arrival. Various other serious sequelae were common among the survivors with clinical blindness.

Trial registration: ClinicalTrials.gov NCT 01540838.

Figure 1

Etiology of bacterial meningitis among the clinically blind and not-blind children, in Finland, Latin America and Angola.

Figure 2

Glasgow Coma Score at admission among the clinically blind and not-blind children in Angola.

Figure 3

Flow-chart of Angolan children with bacterial meningitis and clinical blindness on day 7, at discharge and at follow-up visit. *Children whose sight was not evaluated on day 7.