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.

Emerging serotype III sequence type 17 group B streptococcus invasive infection in infants: the clinical characteristics and impacts on outcomes

“…In our institute, all positive GBS cultures were collected before antibiotics were given to infants. Early-onset disease (EOD) and late-onset disease (LOD) were defined as disease occurred between 0 and 7 days of age and between 8 and 90 days of age [6, 11, 12], respectively. Disease occurred after 90 days of age was classified as late LOD (LLOD) [6, 11, 12].…”

“…Early-onset disease (EOD) and late-onset disease (LOD) were defined as disease occurred between 0 and 7 days of age and between 8 and 90 days of age [6, 11, 12], respectively. Disease occurred after 90 days of age was classified as late LOD (LLOD) [6, 11, 12]. Invasive GBS disease was defined as GBS infection with GBS strains isolated from a sterile site, including blood, urine, cerebrospinal fluid (CSF), soft tissues (necrotic tissues, abscesses, or cellulitis), pleural or peritoneal fluids.…”

“…Invasive GBS infections in infants are of great concern, because a significant proportion of infants may have life-threatening meningitis, pneumonia, and bacteremia [7–11]. Recent studies also found poor long-term outcomes in GBS-infected infants, including an increased risk of death and chronic morbidities such as cerebral palsy, epilepsy, and various neurological sequelae [10–12].…”

Prevalence of pyogenic meningitis in a Tertiary Care Hospital of Sindh.

“…7 The complications are developmental delay, epilepsy, mental retardation, spasticity, hearing problem, visual problem, speech problem and behavioral disorders. 8 Bad prognostic signs includes, age at onset of illness less than 6 months, episodes of seizures, acute complications like coma, focal neurological signs and low CSF glucose. 9 Pyogenic Meningitis is an alarming condition related to increase in mortality and morbidity.…”

The correlation between MRI findings and clinical prognosis in children with purulent meningitis

“…A study [20] showed that in 77 cases the probability of neurological complications was 43%, including subdural effusion (28.6%), cerebral hemorrhage; encephalitis (3.9%), hydrocephalus (2.6%), subdural hematoma, brain abscess, subdural empyema, abscess of ventriculitis (1.3%). A study [21] showed that the common neurological complication were subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), and hydrocephalus (18.8%). Encephalomalacia, hydrocephalus, ventriculomegaly, increased intracranial pressure were associated with a significantly higher rate of major neurological sequelae at discharge.…”