Profound Sensorineural Hearing Loss Following Adjuvant Steroid Delay in Pediatric Bacterial Meningitis

Abstract

Streptococcus pneumonia is a gram positive, polysaccharide-encapsulated diplococcus associated with various pulmonary and extra-pulmonary clinical presentations including invasive diseases such as acute meningitis. It can be associated with high rates of morbidity and mortality in both the pediatric and the adult populations. The introduction of the pneumococcal conjugate vaccine which expanded to cover 13 strains allowed remarkable protection against these invasive infections. In addition, the use of adjuvant corticosteroid therapy in the last few years; in particular dexamethasone, for the management of acute bacterial meningitis reduced the incidence of severe hearing loss in both Hib and other bacterial meningitis. The IDS guidelines recommend administering the first dose of steroids just before or with the start of antibiotics due to its decreased effectiveness with the late presentations of meningitis. We present the case of a 14-year-old female adolescent refugee, with incomplete vaccination status prior to relocating to Lebanon presenting with pneumococcal meningitis. Her hospitalization was complicated by bilateral profound sensorineural hearing loss (SNHL) following a delay in steroid administration. The aim of this article is to highlight the role of vaccines in decreasing morbidity of vaccine-preventable illnesses, and the importance of early administration of steroids as adjuvant to therapy for prevention of neurologic sequeleae.