ABSTRACT
OBJECTIVE: To study the long-term neurological and developmental outcome and the clinical and laboratory predictors of sequelae in children with acute bacterial meningitis (ABM). METHODS: Detailed clinical and demographic data was retrieved from the medical records of study children. Subsequently they were followed up for a minimum of 12 months after discharge for development, neurological and hearing assessment. All sequelae were identified and divided into minor or major. For analysis data was divided into 2 groups those with sequelae and without sequelae at follow-up. Statistical analysis was done using SPSS version 10.00 and Epi Info version 2000. RESULTS: 61 boys and 19 girls, a mean age of 31.4 +/= 41.9 months at the time of ABM, were included in the study. Of these 62.5% children were infants. Mean age at follow-up was 58.6 +/= 47.2 months. Sequelae were observed in 32 (40%) children (8 (10%) minor and 24 (30%) major). Mean social quotient at follow-up was 92.8 +/= 32.6. Developmentally 22 (37.9%) children were normal and 20 (34.5%) had global delay. Seizures (P=0.015), cranial nerve palsy (P=0.0065), abnormal deep tendon reflexes (P=0.002), Glasgow coma scale score (GCS) < 8 (P = 0.044) at admission, a CSF culture positive for bacteria and abnormal findings on ultrasonography or computed tomography of head at admission had significant association with sequelae at follow-up. All children (7/7) who had infarct on CT scan (P=0.001) and 12 (80%) of 15 patients who had hydrocephalus (OR - 9.0, 95% CI - 2.03-45.6, P=0.001) diagnosed on CT scan developed severe sequelae. On multiple regressions GCS score <8, presence of cranial nerve palsy and abnormal deep tendon reflexes were independent predictors of sequelae. CONCLUSION: Neurological and audiological sequelae and global developmental delay may be seen in about one third of survivors of bacterial meningitis. GCS score <8, presence of infarct or cranial nerve palsy, or hydrocephalous on CT/ ultrasound at admission may help in identification of children most likely to need long term follow up and rehabilitation.
Subject(s)
Acute Disease , Child , Child, Preschool , Developmental Disabilities/etiology , Female , Follow-Up Studies , Glasgow Coma Scale , Humans , Infant , Male , Meningitis, Bacterial/classification , Meningitis, Pneumococcal/complications , Intellectual Disability/etiology , Nervous System Diseases/etiology , Prognosis , Regression Analysis , Risk FactorsABSTRACT
La mortalidad por meningitis, cercana al 100 por ciento en la era pre-antibiótica, se ha reducido en la década de los años 80 a niveles de seis al 30 por ciento dependiendo de la edad, el agente etiológico y el lugar de estudio. Este descenso se debe al desarrollo de antimicrobianos con adecuada difusión y concentración en el líquido cefalorraquídeo (LCR), sumando al desarrollo de técnicas de diagnóstico rápido. La morbilidad y las secuelas, al contrario, no se han modificado, persistiendo entre 20 y 50 por ciento, debido a la limitación que el tratamiento adecuado ejerce sobre los eventos fisiopatológicos inflamatorios responsables de la evolución y las secuelas. La búsqueda de las estrategias para reducir estos efectos adversos, es el marco conceptual que ha predominado en la investigación de meningitis en los últimos años, buscando definir claramente los eventos fisiopatológicos e investigando su posible control que, junto con la evaluación de nuevos regímenes antibióticos, deben aclarar el futuro de las secuelas secundarias a meningitis bacteriana.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Meningitis, Bacterial/classification , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/etiologyABSTRACT
Aspectos gerais relacionados ao quadro clinico, bacterias mais frequentemente observadas nas diferentes idades, procedimentos laboratoriais e sua interpretacao, tratamento e profilaxia das meningites bacterianas agudas da crianca sao apresentados.