Neurodevelopmental outcome in meningococcal disease: a case--control study

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From: Archives of Disease in Childhood(Vol. 85, Issue 1)
Publisher: BMJ Publishing Group Ltd.
Document Type: Article
Length: 3,764 words

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Abstract

Aims--To determine long term neurodevelopmental outcome following the spectrum of meningococcal infection.

Methods--Between 1988 and 1990, 152 cases of meningococcal disease were recruited; 139 survived. Between 1998 and 1999, 115 survivors (83%) were evaluated, together with 115 sex and age matched controls. Standard measures of neurological function, coordination, cognition, behaviour, and hearing were used to assess neurodevelopmental status.

Results--One case has spastic quadriplegia. Gross neurological examination was normal in all other cases and all controls. Five cases and no controls have significant hearing loss. Cases performed at a lower level than controls on measures of coordination, cognition, and behaviour. Four cases and no controls had major impairments. The adjusted odds ratios for moderate and minor impairments were 3.6 (95% CI 1.3 to 10.3) and 1.6 (95% CI 0.8 to 3.4) respectively.

Conclusion--The majority of survivors from this cohort do not have gross neurological deficits. However, when objective measures of motor function, cognitive ability, and behaviour were applied significant detriments were found in meningococcal survivors.

(Arch Dis Child 2001;85:6-11)

Keywords: meningococcal; meningitis; neurodevelopmental outcome

Over the past 15 years there has been a gradual increase in the incidence of meningococcal disease (MCD) in childhood. [1, 2] There has been extensive research into the clinical features, pathophysiology, and management of the acute illness but less is known about long term sequelae. The majority of follow up studies use mortality as their main outcome measure. [3-6] Those looking at sequelae mainly consider physical problems or hearing loss and rarely obtain information by direct assessment. [7-11]

In the only detailed prospective case--control study, Moss [12] assessed 60 survivors from the outbreak in Bolton from 1971 to 1974. He found no significant differences on detailed neurological examination or on psychometric assessment; 5% of cases showed unilateral sensorineural deafness. These data are not likely to be relevant now. This cohort suffered high mortality of 17%. There have also been changes in classification and epidemiology of MCD together with advances in paediatric intensive care unit (PICU) management.

Cases of meningococcal disease may be classified on clinical and laboratory grounds into septicaemia (approximately 30% in outbreaks), meningitis (10%), or mixed disease (60%). [13] Thus 70% of cases have meningitis as part of their illness. In a meta-analysis of 19 prospective studies involving 1434 patients with meningitis in developed countries, Baraff and colleagues [14] found an overall mortality of 4.5% and a 15% incidence of major neurological sequelae. A total of 227 of these patients had meningococcal infection; although mortality was higher (7.5%) than for other causative organisms, neurological morbidity was documented in 10%. More recent studies have documented minor neurodevelopmental problems in a further 19% of survivors of bacterial meningitis but have included only small numbers of MCD cases. [15, 16] Septicaemia alone may also confer a risk of neurodevelopmental sequelae. Thirty per cent of these cases have a fulminant illness involving hypotension and coagulopathy, and require PICU care [1 7]; this may increase survival at the expense of morbidity.

It is likely from this evidence that...

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Gale Document Number: GALE|A77032118