Neurological sequelae after childhood bacterial meningitis

Abstract

The purpose of this study is to evaluate childhood bacterial meningitis (BM): incidence, clinical presentation, causative pathogens, diagnostics, and outcome (neurological sequelae, hearing loss, and death). A retrospective review of all children aged ≤ 16 years and 1 month diagnosed with BM at a tertiary children's centre in the period 2010-2020. The Glasgow Outcome Scale (GOS) was used to assess outcome, with a GOS score of 1-4 considered to be an unfavourable outcome. Logistic regression univariate analysis was used to determine predefined risk factors for death, unfavourable outcome, and long-term neurological sequelae. Seventy-four patients (44 males) with a median age of 8.0 months (range 1 day to 16 years and 1 month) and 77 BM episodes were included in the study. The average incidence rate of BM was 2.2/100,000/year, the majority (91%) being community-acquired BM. Streptococcus pneumonia and Neisseria meningitidis were the most common pathogens 12/77 (16%) each. Neurological sequelae at discharge were present in 24 (34%) patients, unfavourable outcome in 19 (25%), and hearing loss (deafness) in two (3%) survivors of BM. Seven (9%) patients died. Long-term neurological sequelae were observed in 19/60 (32%), aphasia/dysphasia being the most common in 10 (17%) BM children. No independent risk factors were identified for long-term neurological sequelae in univariate analysis.

Conclusion: The risk for a fatal course of BM is still remarkable. Neurological sequelae persisted in a substantial proportion of BM survivors in long-term follow-up, aphasia/dysphasia being the most common. Hearing loss (deafness) occurred in 3%. However, no specific risk factors predicting the long-term sequelae were found.

What is known: • Streptococcus pneumonia and Neisseria meningitidis were the most common pathogens causing bacterial meningitis. • Risk for fatal course of bacterial meningitis (BM) remains remarkable despite advances in modern medicine.

What is new: • In long-term follow-up, 1/3 of BM children suffered from neurological sequelae in the 2010s, aphasia and dysphasia being the most common sequelae. • Hearing loss was diagnosed in only two (3%) children, whom of both were deaf.

Keywords: Bacterial meningitis; Child; Deafness; Death; Hearing loss; Neurological sequelae.

Fig. 1

Study flow chart. ^aMeningitis caused by borrelia, or non-bacterial pathogens (virus, fungi, or parasite). ^bBM in a newborn baby with perinatal infection from the birth was considered as nosocomial. ^cIntracranial malignant and benign tumour in one each. ^dBacterial meningitis diagnosed < 30 days after neurosurgery

Fig. 2

Incidence rates and aetiology of childhood bacterial meningitis in Southern Finland, 2010–2020. Other aetiology included Mycobacterium tuberculosis in 2, and gram-positive cocci, Pseudomonas aeruginosa, Staphylococcus epidermis, and Staphylococcus hominis in one each. Unknown aetiology in 22