Risk Factors in Children Older Than 5 Years With Pneumococcal Meningitis

Henaff, Fanny; Lévy, Corinne; Cohen, Robert; Pïcard, Capucine; Varon, Emmanuelle; Guen, C. Gras-Le; Launay, Élise

doi:10.1097/inf.0000000000001470

Cited by 18 publications

(27 citation statements)

References 23 publications

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“…A recent review concluded that about half of survivors with bacterial meningitis suffered from focal neurological deficits ( 27 ); however, most of the studies in the review were conducted more than 10 years ago. When compared with reports from different age groups in recent years, we found neurological complications and sequelae, presented in 23–74% of all young infants (<3 months old) with bacterial meningitis ( 22 , 28 , 29 ), were significantly higher in young infants than children and adults ( 17 , 21 – 25 ), except one study of patients with alcoholism found unfavorable outcomes in 58% of acute bacterial meningitis cases and 25% of patients died ( 30 ).…”

Section: Discussionmentioning

confidence: 63%

“…We propose that different study populations, treatment policies and definitions of CNS complications may account for these different results. Further, different age groups, different causative pathogens, and underlying comorbidities may have different clinical presentations of bacterial meningitis and outcomes ( 17 , 21 – 26 ). A recent review concluded that about half of survivors with bacterial meningitis suffered from focal neurological deficits ( 27 ); however, most of the studies in the review were conducted more than 10 years ago.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, knowledge of the factors associated with poor prognoses could be valuable in selecting patients for more aggressive treatment strategies or at least intensive monitoring, in order to optimize the functional and normal behavioral abilities in neonates, who have had bacterial meningitis. In adult and pediatric settings, risk factors associated with neurological complications and sequelae have been identified, such as specific microorganisms, higher severity of illness, and early presentation of seizure and paresis ( 9 , 10 , 14 – 17 ); however, the conclusions of these studies are conflicting in young infants and only a few population-based cohort studies have been conducted. Therefore, we investigated the occurrence, treatment, and outcome of neurological complications in a large cohort from two medical centers in Taiwan with acute bacterial meningitis.…”

Section: Introductionmentioning

confidence: 99%

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Neurological Complications in Young Infants With Acute Bacterial Meningitis

Hsu

Kuo

et al. 2018

Front. Neurol.

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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.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neurological Complications in Young Infants With Acute Bacterial Meningitis

Hsu

Kuo

et al. 2018

Front. Neurol.

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“…11 Of note, there has been a significant reduction in the incidence of L. monocytogenes meningitis in this age group due to the efforts in decreasing the incidence of listeriosis during pregnancy by reducing food-borne contamination. 7 Children After the Neonatal Period Despite the significant reduction in the incidence of meningitis in this age group after the introduction of vaccines to the three most common meningeal pathogens, S. pneumoniae and N. meningitides remain the most common organisms causing community-acquired bacterial meningitis 7,[17][18][19] followed by GBS and gram-negative bacilli organisms.…”

Section: Neonates and Infantsmentioning

confidence: 99%

<p>Management of Acute Bacterial Meningitis in Children</p>

Alamarat¹,

Hasbun²

2020

IDR

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Acute community-acquired bacterial meningitis (ABM) in children continues to have high rates of neurological morbidity and mortality despite the overall declining rates of infection attributed to the use of vaccines and intrapartum Group B Streptococcus prophylaxis. Prompt diagnosis and early antibiotic therapy are crucial and should not be delayed to obtain cranial imaging. Differentiating bacterial from viral meningitis continues to be a clinical dilemma especially in patients with previous antibiotic exposure. Clinical models and inflammatory biomarkers can aid clinicians in their diagnostic approach. Multiplex polymerase chain reaction and metagenomic next-generation sequencing are promising tools that can help in early and accurate diagnosis. This review will present the epidemiology of ABM in children, indications of cranial imaging, role of different models and serum biomarkers in diagnosing ABM, and management including the use of adjunctive therapies and methods of prevention.

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“…30% of those patients had a complement deficiency. [25] The lymphocyte subpopulations of T and B cells were within the normal range with normal or slightly increased lymphocyte mitogenic responses in the study by Lorraine et al 1981 [14,22,26].…”

Section: )mentioning

confidence: 82%

Evaluation of primary immunodeficiency in patients with meningitis in fever hospitals

Eldarawy

Hesham

Almalky

et al. 2019

Zagazig University Medical Journal

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Background:The hallmark of primary immunodeficiency diseases is increased susceptibility to recurrent, severe and opportunistic infections. In this study we evaluate patients with meningitis for underlying primary immunodeficiencies. Methods: During the period from August 2016 to February 2017, thirty infant and children patients (16 males and 14 females) with age ranged from 40 days to 15 years participated in the study were admitted to Faqus and Zagazig fever hospitals with meningitis were evaluated for primary immunodeficiencies by measurement of serum immunoglobulin levels, assessment of T-Cell Receptor Excision Circles and assessment of complement system by CH50 assay. Results: This study showed that (50%) had deficient IgG, (20%) had deficient IgA, (30%) hyper IgE, (30%) hyper IgM and 10% deficient in all immunoglobulins. The study also showed that (43.3%) of the study group had TREC deficiency, (36.7%) were CH50 deficient and 26.7 had both TREC and CH50 deficiency. Conclusions: Meningitis may be the presenting manifestation of immunodeficiency diseases as there is high incidence of primary immune deficiency in patients with meningitis. TRECS and CH50 are decreased in most cases of meningitis which indicate high percentage of primary immunodeficiency diseases among those patients.

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Risk Factors in Children Older Than 5 Years With Pneumococcal Meningitis

Abstract: We describe the largest cohort of children >5 years old with pneumococcal meningitis. One third of the children had risk factors justifying a complete immunologic and radiologic work-up.

Cited by 18 publications

References 23 publications

Neurological Complications in Young Infants With Acute Bacterial Meningitis

Neurological Complications in Young Infants With Acute Bacterial Meningitis

<p>Management of Acute Bacterial Meningitis in Children</p>

Evaluation of primary immunodeficiency in patients with meningitis in fever hospitals

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