II.7) COMPLICATIONS OF BACTERIAL MENINGITIS IN
CHILDREN
Meningococcal disease remains a major cause of morbidity and
mortality in childhood. Neurological disorders in children are common
occurrences in clinical practice. The disorder accounts for more than 170.000
deaths worldwide each year with majority of people affected living in Africa
[56][ 57].
Young children are particularly vulnerable to bacterial
meningitis, and when exposed poor outcomes may occur due to the immaturity of
their immune systems [57]. Two thirds of meningitis deaths in
low income countries occur among children less than 15 years of age. These
complications could be classified as [57]; short term, middle
term and long term.
SHORT TERM
- Brain edema is an early life threatening
complication, in which brain structure changes is not usually found in 80%, but
the residual stage of bacterial meningitis is characterised by cerebral
destructive /proliferative or atrophic changes of different severity
[58].
-
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MID TERM
- Seizure could be placed in this term. Most
children present with recurrent seizure disorder.Seizures that occur early in
the course of bacterial meningitis are easily controlled and are rarely
associated with permanent or long term neurologic complications. In contrast,
seizures that are prolonged, difficult to control, or begin more than 72 hours
after hospitalization are more likely to be associated with neurologic
sequelae, suggesting that a cerebrovascular complication may have occurred
[57].
- Paresis: It is usually present but resolve
with time, which typically resolves from and intracranial abnormality suh as;
cortical vein, sagittal vein thrombosis, central artery spasm, subdural
effusion or empyema and cerebral infarct [57].
LONG TERM
The incidence , type and severity of sequelae is influenced by
infecting organisms, age of child and severity of acute illness , but it can be
difficult to predict with children.The potential impact of the illness is
further complicated by the fact that some of these sequelae may not become
apparent until months or years after the acute illness.These long term
complications include ;Visual loss ,Cognitive delay, Speech/language
disorders[,Behavioral problems,motor delay/impairment and attention deficit
hyperactivity[57].
- Hearing loss: It might be transient or
permanent. Transient hearing loss may be secondary to a conductive disturbance
affecting many patients. Permanent damage results from damage to the eighth
cranial nerves, bacterial invasion, cochlea or labyrinth induced by direct
bacterial invasion and /or inflammatory response elicited by the infection
[57].
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II.8) PUBLICATIONS ON MENINGITIS OUT OF
AFRICA
· Almuneef et al in 1998 analysed bacterial etiologies
and outcome of childhood meningitis in Saudi Arabia and in his study there was
a predominance of female sex, also the most affected age being from 3 months of
age to 5 years. The presenting complaints in his study appearing in order of
decreasing frequency were; fever 86 %, vomiting 29 %, poor feeding 19 %,
seizure 14 % and lethargy 14 %[59]
· Franco -Paredes et al reviewed acute bacterial
meningitis cases in 2008, in Mexican patients aged from 1 month of age to 18
years, recorded the most affected group by bacterial meningitis to be between
1-6 months, with Hib being the common pathogen found in 50% of cases. Incidence
proven to have declined significantly after the introduction of appropriate
vaccins [60].
· Nicole Le Saux in 2014 reviewed the current
epidemiology of bacterial meningitis in children beyond the neonatal period in
Canada, and came to the conclusion that the incidence of bacterial meningitis
in infants and children has decrease since the routine use of conjugated
vaccines targeting Hib, Streptococcus pneumoniae, and Neisseria
meningitidis [61]
· Polkowska et al presented in Finland Streptococcus
pneumoniae and Neisseria meningitidis to be the most common pathogens with an
incidence drop from 1.88 to 0.70 in 2014[62].
· Incidence of bacterial meningitis dropped in Japan
from the records of Shingoh in 2015 of 1.19 in 2009-2010 to 0.37 in 2013 -2015,
confirming the efficacy of the Hib and PCV introduction
[63].
IN AFRICA
· In Niamey, in Niger in 1999, using a retrospective
surveillance on cases of laboratory diagnosed bacterial meningitis from
1981-1996 showed that the majority of cases were caused by Neisseria
meningitidisat 57 %, and there was a predominance of meningitis in males
occurring the dry season[64]
· Koko in Libreville, Gabon had predominance in the
female sex among the admissions of children with bacterial meningitis in 2000,
he also noted the highest mortality in children with less than 1 year of
age[65]
·
27
Mullan et al in 2011, evaluating records of cerebrospinal
fluid samples between 2000 to 2008 at Princess Marina hospital in Gabonone,
Botswana, reported Streptococcuspneumoniae(n=125) and
Haemophilusinfluenzae(n=60) to be the most common bacteria cultured,
present in less than or equal to 12 years old and less than 5 years
respectively. The author also reported the climatic tendency of the pathogens,
where Haemophilus influenza was mostly common between April and
September, while Streptococcus pneumoniae most common between May and
October[66]
· In Nigeria , Frank - Briggs in a study followed
patients post meningitis to assess outcome post admissions in 2013 , and had 94
cases with neurological sequelae, notably recurrent seizures being the most
common complication[57].
· Touré et al recorded a total number of 31 cases
out of 833 CSF specimens analysed and had Streptococcus pneumoniae,
followed by Neisseria meningitidis being the most common pathogens
[8].
IN CAMEROON
· Sile et al in a study done in Garoua Provincial
Hospital in the North region of Cameroon in 1999, reported bacterial meningitis
to be responsible for 5 % of consultations and 9 % of hospitalisation. Children
less than 5 years affected at 41 % [67].
· Fonkoua et al conducted a study in 2001 at Centre
Louis Pasteur in Yaoundé, demonstrated that the main etiological agents
detected in samples of cerebrospinal fluid sent to this laboratory, were
Streptococcus pneumoniae at 56%, followed by Haemophilus
influenzae 18%, also noting that, the 4 strains of Neisseria
meningitidis of serotypes W135 were found isolated[68]
· Gervaix et al reported in 2012 in a study that only 62
% of theStreptococcuspneumoniaetype in Cameroon are covered by
vaccins, bringing out the question on the certainty of the vaccination against
bacterial meningitis and its impact in this country[69]
· Nguefack et al demonstrated in 2014 in a retrospective
study conducted at YGOPH that the incidence of bacterial meningitis was high in
Cameroon with Haemophilus influenzae being the most common pathogen
responsible of bacterial meningitis in children with 39.2%, followed by
Streptococcus pneumoniae with 31.6% and
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Neisseria meningitidis least with 10.5%.There was a
high mortality observed with poor prognostic factors as ; age, attitude in
treatment , pathogen incriminated (for this particular study pneumococcal
meningitis) and emphasis was done on the strengthening of routine immunization
on vaccines preventable diseases of infants and children[3]
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CHAPTER THREE
MATERIALS AND METHODS
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