Sequelae Of Meningitis Research Articles

Bacterial Meningitis and Hearing Impairment: A Prospective Study

The purpose of this study is to demonstrate the incidence and the pattern of post-meningitis hearing impairment. A prospective study of 68 meningitis patients was performed. The patients' hearing was evaluated immediately following acute illness and periodically checked for two years. The incidences of the initial sensorineural and conductive deafness were 26.4% and 20.6%, respectively. Two patients (3%) suffered from mixed deafness. No consistent audiometric pattern was found in the cases of sensorineural hearing loss. Serial hearing evaluations demonstrated complete recovery of all cases of conductive hearing loss with only a slight improvement in the low tones noted in one patient with sensorineural hearing loss. No late development of sensorineural loss has occurred.

Meningitis bei 154 Kindern einer Kinderklinik in Deutschland: Klinische und epidemiologische Aspekte

In a retrospective study, the histories of the non-neonates treated for primary meningitis in the Pediatric Department of Mainz University Hospital between 1986 and 1989 were analyzed with regard to etiological, diagnostic, clinical and epidemiological criteria. In the period studied there were 37 cases of infectious meningitis (11 Neisseria meningitidis (29.7%), 7 H. influenzae (18.9%), 3 S. pneumoniae (8.1%), 16 other (43.2%)), and 117 cases of acute aseptic meningitis syndrome (12 mumps virus (10.3%), 3 Borrelia burgdorferi (7.7%), 3 FSME (2.6%), 2 herpes simplex virus, 91 other (77.8%)). Sixty-six percent of the patients were male. Of the infants with infectious meningitis, 68% were under 5 years old. In contrast, 69% of the children with noninfectious meningitis were aged 5 or older. While 70% of the infectious meningitis cases occurred in fall and winter, 64% of the cases of acute aseptic meningitis syndrome occurred in spring and summer. In differential diagnosis between infectious and acute aseptic meningitis syndrome maximal sensitivity was a CRP value exceeding 0.5 mg/dl, a CSF lactate value of over 3 mmol/l and a CSF cell count of over 2000/3 cells. In none of the cases did a second or third lumbar puncture furnish information additional to that which could have been deduced from physical examination and course of temperature. A second lumbar puncture failed to produce unexpected results, or have consequences for therapy, in any of the 14 cases with noninfectious meningitis. Of 37 infants with infectious disease, one (2.7%) died from the sequelae of pneumococcal meningitis. Recovery was partial in 8 (22.2%) of the 36 surviving infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructural localization of albumin transport across the cerebral microvasculature during experimental meningitis in the rat.

Injury to the blood brain barrier (BBB) is a fundamental sequela of bacterial meningitis, yet the precise mechanism facilitating exudation of albumin across the endothelium of the cerebral microvasculature remains conjectural. After intracisternal inoculation of Escherichia coli (0111:B4) lipopolysaccharide in rats to elicit a reversible meningitis and BBB injury, we utilized in situ tracer perfusion and immunolabeling procedures to identify by transmission electron microscopy the precise topography and microvascular exit pathway(s) of bovine serum albumin (BSA). Results revealed that during meningitis there was: (a) an inducible increase in immunodetectable monomeric BSA binding to the luminal membrane of all microvascular segments in the pia-arachnoid and superficial brain cortex; (b) similar uptake of both colloidal Au-BSA (as well as monomeric BSA) by plasmalemmal vesicles but no detectable transcytosis to the abluminal side; and (c) predominant exit of both perfused Au-BSA and immunodetectable monomeric BSA through open intercellular junctions of venules in the pia-arachnoid. This was corroborated in separate experiments documenting focal pial venular leaks of in situ perfused 0.01% colloidal carbon black during experimental meningitis. These results provide precise localization of BBB injury in meningitis to meningeal venules, confirm a paracellular exit pathway of albumin via open intercellular junctions, and suggest an injury mechanism amenable to specific therapeutic intervention.

Hemophilus influenzae

Meningitis constitutes the major infection associated with H. influenzae. Caution must be used when selecting antibiotic treatment based on MIC data, alone, because bacterial levels in the cerebrospinal fluid are higher than those in the blood, on which MICs are calculated. Certain third-generation cephalosporins are effective in producing maximum killing of H. influenzae in the CSF. This strong bactericidal activity may actually prove to be detrimental, however, by augmenting the inflammatory response, and thus contributing to the complications and the sequelae of meningitis. The addition of an agent to block the exaggerated response may be possible.

Bacterial meningitis in children under five years of age in Western Australia.

To describe the epidemiology and the associated mortality and serious neurological sequelae of bacterial meningitis in children under five years of age in Western Australia, and to consider the potential impact of a Haemophilus influenzae type b vaccine on this group of children. A retrospective survey, using multiple sources of case ascertainment. All children in Western Australia from one month to five years of age who developed bacterial meningitis, over a five-year period (from 1984 to 1988 inclusive). Episodes of bacterial meningitis, deaths associated with bacterial meningitis, and sensorineural deafness (requiring hearing aids) and cerebral palsy following bacterial meningitis. Two hundred and seventy episodes of bacterial meningitis were identified; 200 occurred in non-Aboriginal children and 70 in Aboriginal children. There were 16 meningitis-associated deaths (case fatality rate, 5.9%), 7 children developed profound sensorineural deafness and a further 7 children developed cerebral palsy after bacterial meningitis. H. influenzae type b caused nearly 70% of the cases of childhood bacterial meningitis. The annual incidence rate of H. influenzae meningitis was significantly greater in Aboriginal children (150 episodes per 100,000 children under five years of age per year) than in non-Aboriginal children (27 episodes per 100,000), and the mean age of onset of H. influenzae meningitis was significantly lower in Aboriginal children (6.8 months) than in non-Aboriginal children (19.8 months). Any conjugate H. influenzae type b vaccine should be effective when administered to non-Aboriginal children in the first six months of life, but only the most immunogenic vaccines (for example, the vaccine known as PRP-OMP) are likely to be effective in Aboriginal infants.

Achromobacter xylosoxidans An Unusual Neonatal Pathogen

Perinatal acquisition of a rare pediatric pathogen, Achromobacter xylosoxidans, with evidence for in utero transmission, is described. Cultures from the mother and neonate demonstrated A. xylosoxidans. An ascending bacterial infection in the mother with clinical chorioamnionitis is presented as the probable mode of transmission. Postmortem examination of the infant confirmed Achromobacter meningitis. In contrast to the current case with transmission from mother to neonate, previously published neonatal cases of Achromobacter infections indicate that nosocomial transmission of the organism is most common (79%). In addition, the literature review revealed a high mortality associated with meningitis (77%), frequent hydrocephalus, and subsequent neurologic sequelae (36%). To the authors' knowledge, this is the first documented case of maternal-fetal transfer of A. xylosoxidans.

Neurologic Sequelae of Bacterial Meningitis

The occurrence of chronic neurologic sequelae including late seizures or epilepsy was determined in a nine year follow-up study of 185 infants and children with bacterial meningitis at the Departments of Pediatrics and Neurology, Washington University School of Medicine, St. Louis, MO and the Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Seizuresand other neurologic sequelae of bacterial meningitis in children: Pomeroy SL, Holmes SJ, Doge PR, Feigin RD. N Engl J Med. 1990;323:1651–1656

Seizuresand other neurologic sequelae of bacterial meningitis in children: Pomeroy SL, Holmes SJ, Doge PR, Feigin RD. N Engl J Med. 1990;323:1651–1656

Seizures and Other Neurologic Sequelae of Bacterial Meningitis in Children

Although the mortality rate among children with bacterial meningitis has decreased dramatically in recent decades, some patients are left with neurologic sequelae. It has not been clearly established which features of the acute illness predict the chronic neurologic sequelae, including late seizures or epilepsy. We followed 185 infants and children prospectively during and after acute bacterial meningitis. The mean duration of follow-up was 8.9 years (range, 0.1 to 15.5). During the first six years standard neurologic examinations were performed; telephone interviews were conducted thereafter. One month after meningitis, 69 children (37 percent) had neurologic abnormalities. Many of these signs resolved within a year, leaving only 26 children (14 percent) with persistent deficits: 18 (10 percent) had only sensorineural hearing loss, and 8 (4 percent) had multiple neurologic deficits. Thirteen children (7 percent) had one or more late seizures not associated with fever. The presence of persistent neurologic deficits indicative of cerebral injury was the only independent predictor of late afebrile seizures (P less than 0.001). After bacterial meningitis only children with permanent neurologic deficits are at high risk for epilepsy. Those with normal examinations after the acute illness have an excellent change of escaping serious neurologic sequelae, including epilepsy.

Subdural Effusion and Its Relationship With Neurologic Sequelae of Bacterial Meningitis in Infancy: A Prospective Study

One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on longterm follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.

ELISA in tuberculous meningitis: using two mycobacterial antigens does not improve the diagnostic yield compared to either antigen alone

The prevention of the devastating sequelae of tuberculous meningitis (TBM) requires the availability of a reliable test for the rapid diagnosis of this condition. This study was carried out by enzyme-linked immunosorbent assay (ELISA) to measure antimycobacterial immunoglobulin (Ig) G, IgM and IgA in the cerebrospinal fluid (CSF) of 11 patients with culture-proven TBM using a whole cell sonicate of heat-killed M. tuberculosis antigen (MTb) and Bacilli-Calmette Guérin (BCG) antigens. The findings were compared to controls consisting of 13 CSF specimens from patients with proven pyogenic meningitis (PM) and 20 control CSF specimens from individuals with normal findings. The ELISA sensitivity, specificity, positive predictive and negative predictive values for IgG were 73%, 91%, 73% and 91%, respectively, against both antigens. The optical density results for IgM and IgA in the CSF of patients with TBM and controls were too low against both antigens to be considered in any analysis. Although ELISA for detection of anti-mycobacterial antibodies in the CSF provides improvement over conventional methods of microscopy and culture, this approach still needs considerable refinement to make it suited for routine clinical use.

Long-term status of children treated for tuberculous meningitis in South India

This report gives the findings of long-term follow-up ( 4 built1 2 -8 years) of 119 children who recovered from tuberculous meningitis. Of these, 17 patients died (10 due to severe tuberculous meningitis sequelae and 7 due to non-tuberculous causes) and 2 could not be traced. Of the remaining 100 patients for whom information was available, 47 (47 %) made a complete recovery, while 53 (53 %) had neurological sequelae-2 (2 %) had severe, 39 (39 %) moderate and 12 (12 %) mild sequelae. There were no relapses during the 4 1 2 –8 year period, indicating that regular treatment for 12 months may be adequate.

Pneumococcal meningitis: An evaluation of prognostic factors in 164 cases based on mortality and on a study of lasting sequelae

During the period 1966-76, 164 patients with pneumococcal meningitis were admitted to the University Hospital, Copenhagen. Of 111 survivors 94 underwent a series of clinical examinations. The findings in each patient were assessed for their aetiological relationship to meningitis. Of these patients 54% had neurological sequelae, 42% had neuropsychological sequelae, 25% had otological sequelae and 16% had sequelae as judged by computer-assisted tomography of the brain. On the basis of the general clinical condition, each patient was evaluated for the presence of sequelae of meningitis by means of a rating of nil, mild, moderate or severe. These ratings and mortality rates were used to evaluate the prognostic significance of various features present during the acute illness. A fatal outcome was significantly associated with increasing age, concomitant pneumonia, altered consciousness on admission, transfer from another hospital and development of complications while in hospital. There was a statistically significant association between lasting sequelae and the female sex, the age group of 16-50 years, patients who had not received any pre-admission antibiotic therapy and those with positive bacterial cultures of specimens from sites other than blood or cerebrospinal fluid.

Long Term Sequelae of Bacterial Meningitis in Children

Long Term Sequelae of Bacterial Meningitis in Children

Long term sequelae of bacterial meningitis in children.

Long term sequelae of bacterial meningitis in children.

A Comparative Study on CT and Neurological Sequelae in Bacterial Meningitis in Children

A Comparative Study on CT and Neurological Sequelae in Bacterial Meningitis in Children

Problems in the diagnosis of tuberculous meningitis.

Tuberculous meningitis is uncommon in North America. A review of all cases of acute tuberculous meningitis seen at the Vancouver (British Columbia) General Hospital (VGH), Canada, during the decade 1970 to 1980 showed several important difficulties currently encountered in making the diagnosis of tuberculous meningitis. SUBJECTS AND METHODS All cases of tuberculous meningitis recorded by the Medical Records Department and laboratory of VGH were reviewed. The only patients excluded were those without active disease who were admitted for treatment of the sequelae of tuberculous meningitis. The 15 patients in this study included nine with positive CSF cultures for Mycobacterium tuberculosis , two where the organism was isolated from the respiratory tract but not from the CSF, and one that was diagnosed post mortem by the demonstration of acid-fast bacilli in brain sections. The remaining patients were considered to have tuberculous meningitis on the basis of clinical findings and response to treatment.

Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis.

Thirteen infants with compartmentalization of the lateral ventricles diagnosed by air encephalography, computerized tomography, or autopsy are reported. In each case, the body of one or both lateral ventricles was completely divided by a membrane posterior to the foramen of Monro. Recognition of this entity is important from both therapeutic and prognostic standpoints.

Bacterial Meningitis: Newer Concepts of Pathophysiology and Neurologic Sequelae

Bacterial meningitis remains a very significant problem, having increased in frequency during the past several decades. This discussion highlights current concepts of pathophysiology, diagnosis, and treatment. In addition, specific attention is drawn to various sequelae of meningitis, and to certain clinical and laboratory findings which may be of value in predicting which sequelae will occur.

Diagnosis and Treatment of Epilepsy: Overview and General Principles

The management of a patient with epilepsy requires the physician to address himself to two basic tasks: (1) an accurate diagnosis must be made with special attention to the possibility of progressive intracranial disease; and (2) an effective regimen for control of the seizures must be devised. DIAGNOSTIC CONSIDERATIONS ASSOCIATED WITH AGE Seizures beginning in infancy are accompanied, in about half of cases, by other evidence of cerebral damage, especially mental subnormality. The precise pathology often cannot be determined during life, although a cerebral developmental defect or birth injury is usually responsible. In a small proportion of cases a metabolic error, subdural hematoma, neuronal degenerative disease, or some other progressive process will be revealed by a history of deterioration in skills previously acquired. The diagnosis can then be established by other characteristic signs of the condition under consideration and appropriate laboratory studies. Grand mal, focal seizures and minor motor seizures are the types usually encountered in infancy. The same factors which commonly cause seizures in infancy continue to initiate seizures in childhood and early adolescence, but to a steadily decreasing extent. Thus, seizures due to a birth injury, like most post-traumatic seizures, usually begin within 24 months after the traumatic incident1; however, they may be delayed until late childhood or adolescence. Seizures appearing as a sequela of meningitis or other infections are sometimes similarly delayed. After the second year of life, seizures of unknown cause rapidly increase in incidence, including cases of so-called genetic epilepsy. In the latter, centrencephalic seizure bursts (3/sec wave and spike discharges) appear diffusely in the EEG, not only in patients, but in 45% of their asymptomatic siblings (aged 4 to 16 years), as well.