ISPUB.COM The Internet Journal of Infectious Diseases Volume 9 Number 2 1 of 6 Acute Neurologic Complications And Long Term Sequelae Of Bacterial Meningitis In Children S Namani, E Kuchar, R Koci, K Dedushi, M Mehmeti, V Krasniqi Citation S Namani, E Kuchar, R Koci, K Dedushi, M Mehmeti, V Krasniqi. Acute Neurologic Complications And Long Term Sequelae Of Bacterial Meningitis In Children. The Internet Journal of Infectious Diseases. 2010 Volume 9 Number 2. Abstract Mortality and morbidity rates are high among children with acute bacterial meningitis, especially in young ages. A im: to determine the most common neurologic complications during the acute phase of childhood bacterial meningitis and long term sequelae. Material and methods: A total of 277 children (aged 0-16years) were evaluated for acute neurologic complications following bacterial meningitis at the Infectious Diseases Clinic in Prishtina (Kosovo) in years 1997-2002. The authors have analyzed the sequelae that persisted during the three year follow-up period. Results: Of the 277 children treated for bacterial meningitis, 60 children developed neurologic complications (22%) and 15 died (5%). The acute neurologic complications observed were: subdural effusion (35), seizures (31), hydrocephalus (7), 2 cases of subdural empyema and single case of spinal abscess, quadriparesis, vision loss, cerebritis, subdural hematoma and intracerebral hemorrhage. Fifteen children (5%) underwent neurosurgical intervention: 6 children with subdural effusion, 5 with obstructive hydrocephalus, 2 with subdural empyema and one child with subdural haematoma. Long term sequelas were observed in 28 patients (10%): late seizures (24), hydrocephalus (5), deafness (3) neuropsychological impairment (3) and a single case with quadriparesis and partial amaurosis. Conclusion: Neurologic complications of bacterial meningitis are frequent with subdural effusion being the most common during the acute phase of meningitis. Half of neurologic complications resolved within three years of follow up: only 10% of children were left with long term sequelae with late seizures being the most common. INTRODUCTION Bacterial meningitis is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. Despite effective antimicrobial and supportive therapy, mortality rates remains high (from 20-30%) with significant long-term sequelae in survivors 1,2,3 . The risk of death or developing complications is related to the age and underlying condition of the patient, the etiologic agent, the severity and duration of illness at the time of presentation, and, occasionally, delays in the initiation of antibiotic therapy 4 . As many as 50% of survivors experience neurological sequelae, such as hearing impairment, seizure disorders and learning and behavioral problems 5,6,7 . Neurological complications of BM in children include subdural effusion or empyema, cerebral abscess, seizures, hydrocephalus, focal deficits (hearing loss, cranial nerve palsies, hemiparesis or quadriparesis), cerebrovascular abnormalities, neuropsychological impairment, and developmental disability. Seizures are more often seen during the acute stage of the disease 8,9,10,11 . MATERIAL AND METHODS A retrospective study of 277 children (aged 0-16 years, median 2 years, 162 boys) treated for BM at the Infectious Diseases Clinic in Prishtina (Kosovo) in years 1997-2002. All the data for cases of bacterial meningitis in children were gathered prospectively while the analysis was done retrospectively. Patients included: 7 neonates, 108 infants, 37 children aged 1-2 years, 56 aged 3-5 years, 45 aged 6-10 years and 24 aged 11-16 years. With exeption of some neonates treated in neonatology ward, every bacterial meningitis case in a child < 16 years from Kosovo was send to our department. The diagnosis of bacterial meningitis was based on WHO criteria: clinical symptoms (e.g. fever, meningeal signs) and changes in cerebro-spinal fluid (CSF): pleocytosis (>100 /mm 3 ) and either direct (positive blood or CSF culture) or indirect (positive latex agglutination test or CSF Gram stain) confirmation of bacterial presence. The etiology was confirmed by culture in 124 cases (45%); 71 mengococcus, 22 H.influenzae, 17 pneumococcus and 11 gram-negative bacilli cases were observed. The diagnose of neurologic complications was made by neurological examination, neuroimaging, electroencephalografy and by