Bacterial meningitis in children: Neurologic complications
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
Bacterial meningitis continues to result in substantial morbidity and mortality despite the availability of effective antimicrobial therapy. The risk of dying or of developing complications is related to the age and underlying condition of the patient, the causative pathogen, the severity and duration of illness at the time of presentation, and, occasionally, to delays in the initiation of antibiotic therapy. (See "Bacterial meningitis in children older than one month: Treatment and prognosis".)
The neurologic complications of bacterial meningitis in children will be discussed here. The neurologic complications of bacterial meningitis in neonates and adults, and the prevention of neurologic complications in children, are discussed separately. (See "Bacterial meningitis in the neonate: Neurologic complications" and "Neurologic complications of bacterial meningitis in adults" and "Bacterial meningitis in children: Dexamethasone and other measures to prevent neurologic complications".)
Complications of bacterial meningitis can be divided into systemic and neurologic. Systemic complications, such as septic shock, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and septic or reactive arthritis are usually the consequence of the bacteremia that frequently accompanies meningitis. (See "Bacterial meningitis in children older than one month: Clinical features and diagnosis", section on 'Complications'.)
The neurologic complications of meningitis may be sudden or gradual in onset and can appear at any time after the onset of symptoms, including after the completion of therapy. Although many neurologic complications are severe and readily apparent, others, such as hearing loss, may be subtle or inapparent during the early phases of infection. The neurologic complications of meningitis include:
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- Kaplan SL, Catlin FI, Weaver T, Feigin RD. Onset of hearing loss in children with bacterial meningitis. Pediatrics 1984; 73:575.
- Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 1993; 12:389.
- Chandran A, Herbert H, Misurski D, Santosham M. Long-term sequelae of childhood bacterial meningitis: an underappreciated problem. Pediatr Infect Dis J 2011; 30:3.
- Olarte L, Barson WJ, Barson RM, et al. Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis in US Children. Clin Infect Dis 2015; 61:767.
- Kim KS. Bacterial meningitis beyond the neonatal period. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.425.
- Herson VC, Todd JK. Prediction of morbidity in Hemophilus influenzae meningitis. Pediatrics 1977; 59:35.
- Anderson V, Bond L, Catroppa C, et al. Childhood bacterial meningitis: impact of age at illness and acute medical complications on long term outcome. J Int Neuropsychol Soc 1997; 3:147.
- Anderson V, Anderson P, Grimwood K, Nolan T. Cognitive and executive function 12 years after childhood bacterial meningitis: effect of acute neurologic complications and age of onset. J Pediatr Psychol 2004; 29:67.
- Koomen I, Grobbee DE, Roord JJ, et al. Hearing loss at school age in survivors of bacterial meningitis: assessment, incidence, and prediction. Pediatrics 2003; 112:1049.
- Kornelisse RF, Westerbeek CM, Spoor AB, et al. Pneumococcal meningitis in children: prognostic indicators and outcome. Clin Infect Dis 1995; 21:1390.
- Arditi M, Mason EO Jr, Bradley JS, et al. Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use. Pediatrics 1998; 102:1087.
- Oostenbrink R, Maas M, Moons KG, Moll HA. Sequelae after bacterial meningitis in childhood. Scand J Infect Dis 2002; 34:379.
- Feldman WE. Concentrations of bacteria in cerebrospinal fluid of patients with bacterial meningitis. J Pediatr 1976; 88:549.
- Feldman WE, Ginsburg CM, McCracken GH Jr, et al. Relation of concentrations of Haemophilus influenzae type b in cerebrospinal fluid to late sequelae of patients with meningitis. J Pediatr 1982; 100:209.
- Lebel MH, McCracken GH Jr. Delayed cerebrospinal fluid sterilization and adverse outcome of bacterial meningitis in infants and children. Pediatrics 1989; 83:161.
- Taft TA, Chusid MJ, Sty JR. Cerebral infarction in Hemophilus influenzae type B meningitis. Clin Pediatr (Phila) 1986; 25:177.
- Kaaresen PI, Flaegstad T. Prognostic factors in childhood bacterial meningitis. Acta Paediatr 1995; 84:873.
- Kaplan SL, Goddard J, Van Kleeck M, et al. Ataxia and deafness in children due to bacterial meningitis. Pediatrics 1981; 68:8.
- Schwartz JF. Ataxia in bacterial meningitis. Neurology 1972; 22:1071.
- Roine I, Pelkonen T, Bernardino L, et al. Ataxia and Its Association with Hearing Impairment in Childhood Bacterial Meningitis. Pediatr Infect Dis J 2015; 34:809.
- Feldman WE. Relation of concentrations of bacteria and bacterial antigen in cerebrospinal fluid to prognosis in patients with bacterial meningitis. N Engl J Med 1977; 296:433.
- Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD. Seizures and other neurologic sequelae of bacterial meningitis in children. N Engl J Med 1990; 323:1651.
- Madagame ET, Havens PL, Bresnahan JM, et al. Survival and functional outcome of children requiring mechanical ventilation during therapy for acute bacterial meningitis. Crit Care Med 1995; 23:1279.
- Feigin RD, McCracken GH Jr, Klein JO. Diagnosis and management of meningitis. Pediatr Infect Dis J 1992; 11:785.
- Tunkel AR, Scheld WM. Pathogenesis and pathophysiology of bacterial meningitis. Clin Microbiol Rev 1993; 6:118.
- Tureen JH, Dworkin RJ, Kennedy SL, et al. Loss of cerebrovascular autoregulation in experimental meningitis in rabbits. J Clin Invest 1990; 85:577.
- Goitein KJ, Tamir I. Cerebral perfusion pressure in central nervous system infections of infancy and childhood. J Pediatr 1983; 103:40.
- Dodge PR, Davis H, Feigin RD, et al. Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med 1984; 311:869.
- Kaplan SL, Woods CR. Neurologic complications of bacterial meningitis in children. Curr Clin Top Infect Dis 1992; 12:37.
- Bhatt SM, Lauretano A, Cabellos C, et al. Progression of hearing loss in experimental pneumococcal meningitis: correlation with cerebrospinal fluid cytochemistry. J Infect Dis 1993; 167:675.
- Merchant SN, Gopen Q. A human temporal bone study of acute bacterial meningogenic labyrinthitis. Am J Otol 1996; 17:375.
- Klein M, Schmidt C, Kastenbauer S, et al. MyD88-dependent immune response contributes to hearing loss in experimental pneumococcal meningitis. J Infect Dis 2007; 195:1189.
- Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 1993; 328:21.
- Ellsworth J, Marks MI, Vose A. Meningococcal meningitis in children. Can Med Assoc J 1979; 120:155.
- Dunn DW, Daum RS, Weisberg L, Vargas R. Ischemic cerebrovascular complications of Haemophilus influenzae meningitis. The value of computed tomography. Arch Neurol 1982; 39:650.
- Mankhambo LA, Makwana NV, Carrol ED, et al. Persistent visual loss as a complication of meningococcal meningitis. Pediatr Infect Dis J 2006; 25:566.
- Chang CJ, Chang WN, Huang LT, et al. Cerebral infarction in perinatal and childhood bacterial meningitis. QJM 2003; 96:755.
- Kaplan SL, Fishman MA. Update on bacterial meningitis. J Child Neurol 1988; 3:82.
- Taylor HG, Mills EL, Ciampi A, et al. The sequelae of Haemophilus influenzae meningitis in school-age children. N Engl J Med 1990; 323:1657.
- Sell SH. Long term sequelae of bacterial meningitis in children. Pediatr Infect Dis 1983; 2:90.
- Tejani A, Dobias B, Sambursky J. Long-term prognosis after H. influenzae meningitis: prospective evaluation. Dev Med Child Neurol 1982; 24:338.
- Grimwood K, Anderson VA, Bond L, et al. Adverse outcomes of bacterial meningitis in school-age survivors. Pediatrics 1995; 95:646.
- de Louvois J, Halket S, Harvey D. Effect of meningitis in infancy on school-leaving examination results. Arch Dis Child 2007; 92:959.
- Halket S, de Louvois J, Holt DE, Harvey D. Long term follow up after meningitis in infancy: behaviour of teenagers. Arch Dis Child 2003; 88:395.
- Grimwood K, Anderson P, Anderson V, et al. Twelve year outcomes following bacterial meningitis: further evidence for persisting effects. Arch Dis Child 2000; 83:111.
- Fellick JM, Sills JA, Marzouk O, et al. Neurodevelopmental outcome in meningococcal disease: a case-control study. Arch Dis Child 2001; 85:6.
- Berg S, Trollfors B, Hugosson S, et al. Long-term follow-up of children with bacterial meningitis with emphasis on behavioural characteristics. Eur J Pediatr 2002; 161:330.
- Feldman HM, Michaels RH. Academic achievement in children ten to 12 years after Haemophilus influenzae meningitis. Pediatrics 1988; 81:339.
- de Louvois J, Blackbourn J, Hurley R, Harvey D. Infantile meningitis in England and Wales: a two year study. Arch Dis Child 1991; 66:603.
- Bedford H, de Louvois J, Halket S, et al. Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ 2001; 323:533.
- Grimwood K. Legacy of bacterial meningitis in infancy. Many children continue to suffer functionally important deficits. BMJ 2001; 323:523.
- Roed C, Omland LH, Skinhoj P, et al. Educational achievement and economic self-sufficiency in adults after childhood bacterial meningitis. JAMA 2013; 309:1714.
- Ritchi L, Jennekens-Schinkel A, van Schooneveld M, et al. Behaviour is not really at risk after surviving meningitis in childhood. Acta Paediatr 2008; 97:438.
- Marlow N, Johnson S. What the teacher needs to know. Arch Dis Child 2007; 92:945.
- Taylor HG, Schatschneider C, Minich NM. Longitudinal outcomes of Haemophilus influenzae meningitis in school-age children. Neuropsychology 2000; 14:509.
- DODGE PR, SWARTZ MN. BACTERIAL MENINGITIS--A REVIEW OF SELECTED ASPECTS. II. SPECIAL NEUROLOGIC PROBLEMS, POSTMENINGITIC COMPLACATIONS AND CLINICOPATHOLOGICAL CORRELATIONS. N Engl J Med 1965; 272:954.
- Snedeker JD, Kaplan SL, Dodge PR, et al. Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study. Pediatrics 1990; 86:163.
- Seay AR. Spinal cord dysfunction complicating bacterial meningitis. Arch Neurol 1984; 41:545.
- Almasanu BP, Owensby JR, Pavlakis SG, Edwards JH. Spinal cord infarction in meningitis: polygenic risk factors. Pediatr Neurol 2005; 32:124.
- Haupt HM, Kurlinski JP, Barnett NK, Epstein M. Infarction of the spinal cord as a complication of pneumococcal meningitis. Case report. J Neurosurg 1981; 55:121.
- Iversen C, Lehner A, Mullane N, et al. Identification of "Cronobacter" spp. (Enterobacter sakazakii). J Clin Microbiol 2007; 45:3814.
- Perry JR, Bilbao JM, Gray T. Fatal basilar vasculopathy complicating bacterial meningitis. Stroke 1992; 23:1175.
- Newton NL Jr, Reynolds JD, Woody RC. Cortical blindness following Hemophilus influenzae meningitis. Ann Ophthalmol 1985; 17:193.
- Ackroyd RS. Cortical blindness following bacterial meningitis: a case report with reassessment of prognosis and aetiology. Dev Med Child Neurol 1984; 26:227.
- Tepperberg J, Nussbaum D, Feldman F. Cortical blindness following meningitis due to hemophilus influenzae type B. J Pediatr 1977; 91:434.
- Prediction of risk
- ALTERED MENTAL STATUS
- INCREASED INTRACRANIAL PRESSURE
- Cerebral edema
- FOCAL DEFICITS
- Hearing loss
- Cranial nerve palsy
- CEREBROVASCULAR COMPLICATIONS
- NEUROPSYCHOLOGIC IMPAIRMENT
- Cognitive impairment
- Other sequelae
- SUBDURAL EFFUSIONS
- UNUSUAL COMPLICATIONS
- INFORMATION FOR PATIENTS