Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

Abstract

BackgroundBacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age.MethodsA search in MEDLINE and EMBASE was conducted to identify prognostic studies on risk factors for mortality and sequelae after BM in children. Selection of abstracts, full-text articles and assessment of methodological quality using the QUIPS checklist was performed by two reviewers independently. Data on prognostic factors per outcome were summarized.ResultsOf the 31 studies identified, 15 were of moderate to high quality. Due to substantial heterogeneity in study characteristics and evaluated prognostic factors, no quantitative analysis was performed. Prognostic factors found to be statistically significant in more than one study of moderate or high quality are: complaints >48 hours before admission, coma/impaired consciousness, (prolonged duration of) seizures, (prolonged) fever, shock, peripheral circulatory failure, respiratory distress, absence of petechiae, causative pathogen Streptococcus pneumoniae, young age, male gender, several cerebrospinal fluid (CSF) parameters and white blood cell (WBC) count.ConclusionsAlthough several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studies.

Adjunctive Daptomycin Attenuates Brain Damage and Hearing Loss More Efficiently than Rifampin in Infant Rat Pneumococcal Meningitis

“…Long-term sequelae are frequent, especially in resource-poor regions of the world (17,53), and persist for decades, as shown in an Australian study, which documented neurological sequelae (hearing loss, epilepsy, cognitive impairment, and educational problems) in survivors of childhood meningitis up to 12 years after infection (29). Nowadays, Streptococcus pneumoniae is the most common etiological agent of acute bacterial childhood meningitis besides Neisseria meningitidis and is associated with a particularly high rate of hearing loss and other neurological sequelae (16). In both autopsy studies of human victims of bacterial meningitis (48) and experimental models of pneumococcal meningitis (7,22,24,28), cortical necrosis and apoptotic cell death in the dentate gyrus of the hippocampus are reproducible histopathologic correlates of neurological damage.…”

Sensorineural hearing loss after bacterial meningitis in children

“…Литературные данные свидетельствуют о том, что на современном этапе БМ у детей представляют серьезную проблему в педиатрической практике, так как у одного из пяти пациентов с БМ формируются такие неврологические осложнения, как нейросенсорная тугоухость, судороги, нарушение движения, гидроцефалия, другие когнитивные и поведенческие нарушения [9,10,11,12,13]. Установлено, что менингит, вызванный S.pneumоniae, отличается неблагоприятным прогнозом, который приводит к наибольшей смертности, а у 30% выживших вызывает глубокую потерю слуха [12,13].…”

“…Установлено, что менингит, вызванный S.pneumоniae, отличается неблагоприятным прогнозом, который приводит к наибольшей смертности, а у 30% выживших вызывает глубокую потерю слуха [12,13]. Широкое применение современных антибактериальных препаратов, появление вакцин против гемофильной палочки, пневмококка и менингококка существенно снизили уровень летальности от бактериальных менингитов у детей.…”

Risk factors for neurological complications and sequelae in childhood acute bacterial meningitis

“…Dessa forma, recalculamos os valores da Tabela 1 com o teste exato de Fisher e o teste qui-quadrado, quando aplicáveis. As diferenças encontradas foram: fontanela abaulada, p = 0,068 em vez do publicado p = 0, 01,com OR = 3,3 (0,4); irritabilidade, p = 0,044 em vez do publicado p = 0,08, com OR = 4,4 (1,(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)5). Embora esses valores mudem o nível de significância publicado, consideramos de importância vital uma análise estatística com o tamanho amostral ideal a ser calculado.…”

“…Em recente revisão sistemática, Jongue et al 4 avaliaram 31 estudos sobre fatores de prognóstico que se mostraram significativos em predizer sequelas e mortalidade após meningite bacteriana em crianças. Os resultados da revisão mostraram que baixa idade e sexo masculino foram fatores prognósticos estatisticamente significativos em mais de um estudo de moderada/alta qualidade, assim como história clínica com duração maior de 48 horas antes da admissão, coma/alteração do nível de consciência, convulsões com duração prolongada, febre prolongada, choque, falência de circulação periférica, insuficiência respiratória, ausência de petéquias, patógeno causal S. pneumoniae, várias alterações do líquido cefalorraquidiano e da contagem leucocitária.…”