From the Guidelines
Streptococcal meningitis in pediatric patients can lead to severe complications, including neurologic and systemic issues, emphasizing the need for prompt treatment and close follow-up. The most concerning complications include hearing loss, seizures, cognitive impairment, motor deficits, hydrocephalus, vision impairment, and cranial nerve palsies [ 1 ]. In severe cases, children may develop cerebral edema, increased intracranial pressure, cerebral infarction, or brain abscess formation. Long-term neurological sequelae are more common in infants and young children due to their developing nervous systems. Systemic complications can include septic shock, disseminated intravascular coagulation (DIC), and multi-organ failure.
Key Complications and Their Management
- Hearing loss affects up to 30% of survivors, making hearing evaluations crucial [ 1 ].
- Seizures may be acute or develop into epilepsy, necessitating neurological follow-up.
- Cognitive impairment ranges from mild learning disabilities to severe intellectual disability, requiring neurodevelopmental assessments.
- Motor deficits include weakness, spasticity, and coordination problems, which may need physical therapy.
- Hydrocephalus may require shunt placement, and vision impairment or cranial nerve palsies may need specific treatments.
Treatment and Follow-Up
Prompt treatment with appropriate antibiotics, typically a third-generation cephalosporin like ceftriaxone, often combined with vancomycin until susceptibilities are known, is essential to reduce the risk of these complications [ 1 ]. Adjunctive dexamethasone started before or with the first antibiotic dose may help reduce inflammatory complications, particularly hearing loss. Close follow-up with neurodevelopmental assessments and hearing evaluations is crucial for all pediatric survivors of streptococcal meningitis, as estimated that one third of patients surviving an episode of bacterial meningitis will have persisting complaints [ 1 ].
From the Research
Complications of Streptococcal Meningitis in Pediatric Patients
- The potential complications of Streptococcal meningitis in pediatric patients are not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the treatment and outcomes of bacterial meningitis in children, including those caused by Streptococcus pneumoniae 3, 5, 6.
- The complications of bacterial meningitis in general can include hearing impairment, neurologic sequelae, and non-neurologic complications 5.
- A study found that 2 out of 33 patients treated with ceftriaxone for bacterial meningitis were left with persistent hearing deficiencies 3.
- Another study found that the presence or absence of seizures, level of consciousness, Glasgow Coma Score, and duration of signs and symptoms were strong predictors of outcome in children with bacterial meningitis 6.
Treatment Outcomes
- The studies suggest that antibiotic treatment with ceftriaxone, cefotaxime, or cefepime can be effective in treating bacterial meningitis in children, including those caused by Streptococcus pneumoniae 2, 3, 4, 5, 6.
- A meta-analysis found no differences in treatment failure, relapse, mortality, and neurologic complications between shorter and longer duration of antibiotic treatment in children with meningitis 5.
- The eradication rates for Streptococcus pneumoniae were high in both cefepime and comparator arms in a study, with an overall eradication rate of 92% 6.