Neurologic Complications of Bacterial Meningitis

Abstract

Bacterial meningitis is a serious and potentially life threatening CNS infection. It often results in disabling or deaths in 170,000 patients each year worldwide. Younger children are predominantly at risk of bacterial meningitis, mainly because of their immature immune systems and malnutrition while lack of immunization practices also makes them more susceptible to significantly high morbidity & mortality. (Anderson, V. et al., 2004). Even with the provision of highly effective antibiotic therapy, death and long-term disabilities are the common but still seroius consequences of acute bacterial meningitis in developing countries. Common neurological complications in adult are hearing loss, motor deficit, cognition defect and speech problem, whereas sensorineural deafness, followed by seizure disorder and motor deficit are more common in children. Sixteen percent of pediatric patients from developed countries have neurological complications, while this figure rose 26 percent from developing countries. (Braff, LJ. et al., 1993). Two third of all pediatric deaths due to meningitis occur in low income countries and as many as 50% survivors of childhood meningitis experience some neurological sequel. (Mace, SE 2008) Neurological complications of meningitis can occur at any time during the course of disease and even after the completion of therapy. Neurological complications may either be focal or generalized or it may be of sudden or gradual in onset. Patients either remain conscious or may present with altered consciousness or even coma. Usually the complications develop during the course of acute bacterial meningitis but some of them manifest or persist as the long-term sequel such as; hearing loss, epilepsy, hemiplegia, neuropsychological impairment, developmental and learning disabilities. Shock or disseminated intravascular coagulation, frequently is associated with meningococcal meningitis. Pneumococcal meningitis is associated with the highest case fatality rate. Apnea and respiratory failure may occur with any bacterial meningitis, especially in infants. Post meningitis complications may occur in almost half of all cases, 81% of them may present with neurological sequel. A part of this may present with systemic sequel, while a quarter of them have both neurological and systemic complications. (Pfister, HW. et al., 1993)