Severe meningitis often leads to long-term problems

NEW YORK (Reuters Health) - Children who survive a bout of meningococcal sepsis, a life-threatening infection, often suffer from long-term medical problems, including mental retardation and other brain impairments, according to a study from the Netherlands.

Meningococcus bacteria are the most common cause of meningitis, an infection of the brain and spinal cord. However, the bacteria can also infect the bloodstream and result in septic shock, a potentially fatal condition that occurs when bacteria-related toxins trigger a massive response by the immune system that causes tissue damage and a collapse of the cardiovascular system. This relatively rare condition is fatal about 30 percent of the time.

Researchers from Erasmus MC-Sophia Children's Hospital in Rotterdam, led by Dr. Corinne M. P. Buysse, followed up with 120 patients admitted to their pediatric intensive care unit between 1988 and 2001 with meningococcal septic shock.

"We hypothesized that patients who survived meningococcal septic shock in childhood are at a higher risk for adverse physical health outcomes because of the permanent organ damage caused by shock and thrombosis (blood clotting)," they explain in the Archives of Pediatrics and Adolescent Medicine.

Four patients, including one who died prior to this study, developed severe mental retardation with epilepsy; two of them also had spastic quadriplegia (paralysis in all four limbs).

Thirty-nine of the remaining patients (33 percent) had one or more neurological impairments, including two with hearing loss, seven with trouble focusing, and 34 with chronic headaches.

Half of the patients had skin scarring -- in some cases, scars were extremely mutilating -- and "8 percent had amputations (ranging from 1 toe to both legs and 1 arm), and 6 percent had leg-length discrepancies," the report indicates.

During their hospital stay, 19 patients had temporary acute kidney failure. One of these patients had mild chronic kidney failure that "was slowly progressive since discharge."

Overall, general health "scores" on standard assessments were significantly lower in these patients than in the general population, including worse vision, emotional and brain function.

Based on their results, the investigators say standard assessment of vision, emotional distress, and neuropsychological and cognitive functioning is warranted in children who survive meningococcal septic shock.

SOURCE: Archives of Pediatrics and Adolescent Medicine, November 2008.