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Psychiatric Disabilities and Other Long-term Consequences of Childhood Bacterial Meningitis
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.ORCID iD: 0000-0001-9885-2321
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.ORCID iD: 0000-0002-3606-3797
2020 (English)In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 40, no 1, p. 26-31Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bacterial meningitis is known to cause hearing impairments and neurological deficits; however, less is known regarding psychiatric disabilities. In this study, we assessed psychiatric disabilities and other long-term consequences of childhood bacterial meningitis.

METHODS: From a previously validated dataset, we selected children having had bacterial meningitis. We then reviewed medical records and child health records from discharge onwards to identify disabilities. We calculated the occurrence of disabilities with a 95% confidence interval (CI), and we used a χ test to assess possible individual risk factors associated with occurrence of disabilities.

RESULTS: Of the 80 children included in this study, permanent disabilities not attributed to preexisting diseases were noted in 56% (CI: 45-67) during the mean observation period of 19 years and 2 months. Psychiatric disease was diagnosed in 30% (CI: 21-41), and another 5% (CI: 2-13) were under ongoing investigations for symptoms of psychiatric disease. Hearing impairments affected at least 30% (CI: 20-40), and neurological deficits affected at least 23% (CI: 15-34). While other disabilities were often detected within the first year, psychiatric disabilities were detected after a mean time period of 14 years (CI: 11:1-16:11). Although some associations were noted, no individual risk factor was able to predict the occurrence of disabilities.

CONCLUSIONS: Psychiatric disabilities affect more than one-third of survivors and are among the most common long-term consequence of childhood bacterial meningitis. Late discovery and predictive difficulties call for a revision of current guidelines to include a specific long-term strategy for detecting psychiatric disabilities.

Place, publisher, year, edition, pages
Wolters Kluwer, 2020. Vol. 40, no 1, p. 26-31
Keywords [en]
bacterial meningitis, children, disabilities, neurodevelopmental disorders, psychiatric disease
National Category
Infectious Medicine
Research subject
Pediatrics; Infectious Diseases
Identifiers
URN: urn:nbn:se:umu:diva-176359DOI: 10.1097/INF.0000000000002908ISI: 000597406200011PubMedID: 33021593Scopus ID: 2-s2.0-85097587003OAI: oai:DiVA.org:umu-176359DiVA, id: diva2:1485302
Funder
Region VästerbottenThe Kempe FoundationsAvailable from: 2020-11-02 Created: 2020-11-02 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Bacterial meningitis in children: clinical aspects and preventive effects of vaccinations
Open this publication in new window or tab >>Bacterial meningitis in children: clinical aspects and preventive effects of vaccinations
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Bakteriell meningit hos barn : kliniska aspekter och preventiva effekter av vaccinationer
Abstract [en]

Bacterial meningitis, one of the most severe infections a child can contract, can be caused by several different strains of bacteria. Most commonly, Haemophilus influenzae type b (Hib), Streptococcus pneumoniae and Neisseria meningitidis. These colonize the upper respiratory tract, then either cause localized infections acting as primary foci or directly spread to the brain. As preventive measure, general infant Hib and pneumococcal vaccinations were introduced in Sweden in 1993 and in 2009, respectively. Although evaluated extensively elsewhere, their long-term effects in Arctic regions are less studied. For the individual child with bacterial meningitis, treatment involves many challenges starting with correctly identifying the condition, guiding treatment, and finally identifying both short-term and long-term disabilities.

In this thesis, the overall aim was to study clinical aspects of bacterial meningitis and preventive effects of vaccinations in an Arctic region. We used two datasets in the Västerbotten Region to investigate incidence rates during the time-periods adjacent to vaccine introductions. This allowed us to study the preventive effects of general infant vaccinations on bacterial meningitis in one of the Swedish Arctic regions. More precisely, we investigated changes in incidence of bacterial meningitis and sepsis during the period of 1986-2015 and of respiratory tract infections during the period of 2005-2014, in the Västerbotten Region, Sweden. We also reviewed medical records of children being treated for bacterial meningitis in the Västerbotten Region to study clinical presentation, short-term outcome, and to develop a new predictive score for identifying adverse outcome and need of invasive procedures. Additionally, by reviewing medical records and child health records from discharge and onwards we assessed long-term disabilities and evaluated clinical guidelines’ follow-up recommendations.

Following introduction of general infant Hib vaccination, incidence of all-cause bacterial meningitis and Haemophilus meningitis in children aged one month to four years declined by 82.3% and 95.3%, respectively. Likewise, all-cause bacterial meningitis and pneumococcal meningitis declined by 48.0% and 67.5%, respectively, following pneumococcal vaccination. In addition, incidence of sepsis caused by H. influenzae and by S. pneumonia also decreased in the same age group. Finally, respiratory tract infections in children under five years of age decreased following pneumococcal vaccination; by 41.5% for all-cause acute otitis media, by 80.7% for sinusitis and by 28.6% for pneumonia.

At admission to the hospital, difference in clinical presentation mostly depended on age. Younger children were more ill at admission but also presented with more diffuse symptoms. When evaluating clinical decision rules for detecting bacterial meningitis, none reached 100% sensitivity. The predictive score developed by us could identify all children in need of invasive procedures to manage the intracerebral pressure and were graded as excellent in the ROC analysis at this task. However, neither this score nor any other could adequately predict complications or death. Finally, permanent disabilities affected more than half of surviving children with psychiatric disease being diagnosed in 30%, and another 5% had ongoing investigations for symptoms of psychiatric disease. Notably, psychiatric disabilities were detected late, in average 14 years after having had bacterial meningitis.

From these findings, we concluded that vaccinations are excellent at protecting children against bacterial meningitis, also in the Arctic region, with the added bonus of providing protection against sepsis and less severe infections such as pneumonia and acute otitis media. Further, treating children with bacterial meningitis involves several challenges starting with correctly identifying this sever disease. For this task, no clinical decision rule is perfect. When making difficult treatment decisions such as deciding on invasive procedures to manage the intracerebral pressure, the predictive score developed and tested by us, the MeningiSSS, can be very helpful. Finally, permanent disabilities may be more common than previously thought. With more than one third of survivors being affected by psychiatric disabilities, specific long-term follow-up strategies are needed to reduce suffering caused by undetected psychiatric disabilities.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2020. p. 75
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2097
Keywords
Bacterial meningitis, children, vaccination, clinical presentation, decision support techniques, disease management, risk assessment, disabilities, neurodevelopmental disorders, psychiatric disease
National Category
Pediatrics Infectious Medicine
Research subject
Pediatrics; Infectious Diseases
Identifiers
urn:nbn:se:umu:diva-176939 (URN)978-91-7855-356-3 (ISBN)978-91-7855-355-6 (ISBN)
Public defence
2020-12-18, Stora hörsalen, byggnad 5B, plan 6, målpunkt P, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-11-27 Created: 2020-11-19 Last updated: 2021-02-02Bibliographically approved

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Johansson Kostenniemi, UrbanSilfverdal, Sven-Arne

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