One-Year Sequelae and Quality of Life in Adults with Meningococcal Meningitis: Lessons from the COMBAT Multicentre Prospective Study

Abstract

Introduction COMBAT is a prospective, multicentre cohort study that enrolled consecutive adults with community-acquired bacterial meningitis (CABM) in 69 participating centres in France between February 2013 and July 2015 and followed them for 1 year. Methods Patients aged at least 18 years old, hospitalised with CABM were followed during their hospitalisation and then contacted by phone 12 months after enrolment. Here we present the prevalence of sequelae at 12 months in a subgroup of patients with meningococcal meningitis. Results Five of the 111 patients with meningococcal meningitis died during initial hospitalisation and two died between discharge and 12 months, leaving 104 patients alive 1 year after enrolment, 71 of whom provided 12-month follow-up data. The median age was 30.0 years and 54.1% of the patients had no identified risk factor for meningitis. More than 30% reported persistent headache, more than 40% were not satisfied with their sleep and 10% had concentration difficulties. Hearing loss was present in about 15% of the patients and more than 30% had depressive symptoms. About 13% of the patients with a previous professional activity had not resumed work. On the SF-12 Health Survey, almost 50% and 30% had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population. There was a non-significant improvement in the patients’ disability scores from hospital discharge to 12 months ( p = 0.16), but about 10% of the patients had residual disability. Conclusions Although most patients in our cohort survive meningococcal meningitis, the long-term burden is substantial and therefore it is important to ensure a prolonged follow-up of survivors and to promote preventive strategies, including vaccination. Trial Registration ClinicalTrial.Gov identification number NCT01730690. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02149-7.

Epidemiology and Clinical Burden of Meningococcal Disease in France: Scoping Review

“…Higher rates (11.6%) were reported in adult cases with N. meningitidis purpura fulminans [47]. In the same way, a prospective observational study found that 34.3% of adult cases had depressive symptoms one year after being discharged [40]. This outcome was not consistent with a case-control study reporting sequelae 2.8 years following IMD.…”

“…However, the available evidence is scarce. Only one observational study assessed the quality of life of adults survivors one year after the diagnosis, according to the research strategy of the present study [40]. Considering the patient's subjectively perceived wellness may improve the speed and quality of recovery from IMD [69].…”

“…IMD may manifest in multiple clinical presentations. 21 publications reported the proportion of IMD cases by clinical presentation, 9 reported specific data for the pediatric population [21,[32][33][34][35][36][37][38][39] and 2 for the adult population [40,41]. Meningitis followed by septicemia was the most globally common clinical presentation in all age groups (Table 1).…”

“…Reduction of quality of life was mentioned in one observational study. Duval et al reported that 50% and 30% of IMD patients had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population, respectively [40]. 1 All: both children and adults; 2 Adult: patient aged ≥18 years old.…”