Neurodevelopmental outcome in meningococcal disease: a case–control study

Abstract

Aims-To determine long term neurodevelopmental outcome following the spectrum of meningococcal infection. Methods-Between 1988 and 1990, 152 cases of meningococcal disease were recruited; 139 survived. Between 1998 and 1999, 115 survivors (83%) were evaluated, together with 115 sex and age matched controls. Standard measures of neurological function, coordination, cognition, behaviour, and hearing were used to assess neurodevelopmental status. Results-One case has spastic quadriplegia. Gross neurological examination was normal in all other cases and all controls. Five cases and no controls have significant hearing loss. Cases performed at a lower level than controls on measures of coordination, cognition, and behaviour. Four cases and no controls had major impairments. The adjusted odds ratios for moderate and minor impairments were 3.6 (95% CI 1.3 to 10.3) and 1.6 (95% CI 0.8 to 3.4) respectively. Conclusion-The majority of survivors from this cohort do not have gross neurological deficits. However, when objective measures of motor function, cognitive ability, and behaviour were applied significant detriments were found in meningococcal survivors. (Arch Dis Child 2001;85:6-11)

Estudo seccional descritivo de crianças com deficiência auditiva atendidas no Instituto Nacional de Educação de Surdos, Rio de Janeiro, Brasil

“…Multiplicam-se os estudos de levantamento das populações de risco pré, peri e pós-natais, como a de prematuros, asfixiados, portadores de malformações variadas, pacientes com traumatismo crânio encefálico, vítimas de infecções do sistema nervoso central, dentre outras 29,30,31,32 . Avaliações clínicas (inventários de risco) 33 , de imagem (ultra-som transfontanela, tomografias, ressonâncias) 34,35 , neurofisiológicas (eletroencefalogramas e potenciais evocados) 36 e laboratoriais (teste do pezinho, medidas de consumo de oxigênio) 37,38 são meios importantes na investigação de marcadores objetivos que podem auxiliar a diagnosticar eventuais seqüelas ocorridas, a fim de facilitar projetos eficazes de intervenção precoce.…”

Prediction of academic and behavioural limitations in school-age survivors of bacterial meningitis

“…The parents who agreed to participate were sent two questionnaires on academic and behavioural problems (School Achievement Rating Scale (SAR) and Functional Status II (R) (FS-II)) (17) and one questionnaire to check on exclusion criteria. During this process, 826 (51%) children were lost because of various reasons: paediatricians' refusal (n = 205 [12 (17).…”

“…More subtle adverse outcomes such as cognitive, academic and behavioural problems are present in over 20% (4)(5)(6)(7)(9)(10)(11)(12)(13). These problems often remain undetected until the children start school, several years after they have been cured of their meningitis.…”

Commentary: Opportunities to decrease mortality and long-term sequellae associated with meningococcal disease in Africa

“…The rate of severe and moderate hearing loss at 1.6% was actually lower than has been reported in other studies of sequellae among survivors in developed countries. [7][8][9] There is evidence that the hearing loss associated with bacterial meningitis improves with time 8 so part of this difference may be explained by the timing of testing. Another explanation may rest in the unusual age distribution of patients in this study.…”

“…5 This study examined only patients with meningitis and did not evaluate patients with meningococcaemia who have significantly higher case fatality. 6,7 In the study by Hodgson et al, 5 hearing impairment, diagnosed by audiology, was the major sequella and the only significant objective difference identified between patients with meningitis and controls. The rate of severe and moderate hearing loss at 1.6% was actually lower than has been reported in other studies of sequellae among survivors in developed countries.…”