Cognitive Issues

Approximately 10%-15% of children who survive bacterial meningitis infection have severe sequelae such as deafness, motor impairments, epileptic seizures, and learning disabilities (Koomen et al. 2004). It is believed that an additional 20% of meningitis survivors experience more subtle cognitive, academic, and behavioral difficulties (Koomen et al. 2004). Baraff et al. (1993) conducted a meta-analy-sis of all the medical reports that delineated the outcomes of bacterial meningitis published after 1955. Reports from 4,418 children who had acute bacterial meningitis were analyzed to see if the patients experienced any type of neurological sequelae; 10.5% of children had deafness, 5.1% had profound bilateral deafness, 5.1% had mental retardation, 4.2% had spasticity, 3.5% had paresis, 4.2% had seizure disorder, and 83.6% had no detectable sequelae. Prevalence of sequelae varied significantly by type of bacterial agent (Baraff et al. 1993).

Koomen et al. (2003) assessed 149 school-age survivors of bacterial meningitis and found subtle neuropsychological effects in about 20% of children postinfection. The post-bacterial meningitis children were more than twice as likely to repeat a year of school compared with the healthy control subjects. Within this postillness group, children who had hearing loss or language delay were most likely to be referred to special needs schools (Koomen et al. 2003).

Anderson et al. (2004) looked at the cognitive and executive functioning of 109 school-age survivors of bacterial meningitis compared with healthy control subjects and found similar results to those of Koomen et al. (2003). Anderson et al. (2004) found that even though mean IQ scores for the bacterial meningitis group were within the average range, the affected group tended to perform more poorly than healthy control subjects on all measures of the Wechsler Intelligence Scale for Children-III and Wechsler Adult Intelligence Scale-III (used for children ages 17-18 years old).

Age at onset of illness is an important predictor for long-term neurological outcome. Children who contracted meningitis before 12 months of age performed the most poorly on the intellectual tests within the meningitis group. Performance was especially poor in the verbal comprehension and reading domains (Anderson et al. 2004). Psychosocial variables play a role in predicting degree of impairment following illness; social disadvantage and limited access to rehabilitation were found to increase likelihood of cognitive impairment after infection (Anderson et al. 2004).

The vast majority of patients with aseptic meningitis make a full recovery with no neurological or behavioral sequelae (Chang et al. 2007). One study compared 33 eight-year-olds previously infected with enteroviral meningitis between the ages of 4 months and 1 year with healthy sibling control subjects and found that none of the children who had enteroviral meningitis had major neurological sequelae (Bergman et al. 1987). The postmeningitis group performed as well as the sibling control subjects on cognitive and behavioral tests (Bergman et al. 1987). Farmer et al. (1975) followed 15 infants with meningoencephalitis due to coxsackie virus B5 and compared them with 15 control subjects matched by age, sex, socioeconomic status, birth weight, and gesta-tional age. They found no differences in IQ or visual perception tests between children who had viral meningitis and healthy control subjects. Baker et al. (1996) conducted a 3-year prospective evaluation of 16 children with a documented history of enteroviral meningitis in infancy to assess whether postmeningitis infants had deficits in physical growth, development, speech and language, hearing, or intelligence compared with 13 matched control patients. No differences were seen between the two groups in terms of growth, development, hearing, articulation, and expressive language (Baker et al. 1996). Subtle but significant differences were found between the viral meningitis group and the control subjects in terms of receptive language, and these deficits were still present 3 years after infection (Baker et al. 1996). Overall, these studies confirm that serious neurological or cognitive sequelae are rare in children with viral meningitis.

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