Μελέτη των νευρολογικών επιπλοκών από μικροβιακή μηνιγγίτιδα σε παιδιά

Abstract

Thirty children and adolescents with a history of bacterial meningitis beyond the neonatal period and 30 age-matched controls were examined in this cross-sectional study for the presence of systemic complications, Neurological Soft Signs (NSS), eye-hand coordination, competence and behavioral problems. All subjects had a history of bacterial meningitis documented by means of a positive cerebrospinal fluid (CSF) culture and increased CSF leukocytes (>100/ml3) A closed-response questionnaire was used for the collection of data with regards to systemic complications as well as demographics. NSS were assessed with the system devised by Stokman and Shafer. Eye-hand coordination was examined with the Purdue Grooved Pegboard test and competence and behavior were assessed with the Child Behavior Checklist (CBCL), devised by Achenbach. With the CBCL three subsets of competence were assessed (activities, social performance and school performance) and nine subsets of problems (stress, depression, somatic, social, thought, attention, rules, aggression and other) which were also grouped to internalizing, externalizing and total problems. Results: Most of the subjects had a history of meningococcal meningitis (n=16). The remaining cases were caused by Haemophilus type b (n=6), Pneumoniococcus (n=7), while one case was caused by Group B Streptococcus. Two of the subjects had moderate to severe hearing impairment (6.6%) and one had epilepsy (3.3%). There were no children with vision or motor problems. One of the patients with hearing impairment was attending a special needs school. The assessment of NSS revealed no major differences between subjects and controls, with the exception of “motor speed”. In this domain of the NSS assessment, subjects required significantly longer time to complete the timed tasks of the examination. Evaluation of competence and behavioral problems with the CBCL, showed no differences between subjects and controls. Of note is the fact that 4 subjects scored within the clinical spectrum in the “aggression” subset, while no such cases were found amongst the controls, although the difference did not reach statistical significance (P=0.056). Assessment of eye-hand coordination revealed again no difference between subjects and controls. The correlation of NSS with the subset of problems was examined for all the participants of the study. It was found that children who score within the clinical spectrum for “stress” and “internalizing problems” also score higher for “motor speed”. In conclusion, children and adolescents with a history of bacterial meningitis beyond the neonatal period carry a very good prognosis and only a small percentage has systemic complications. Furthermore their assessment for competence, behavioral problems and hand-eye coordination, show the lack of any abnormalities in these domains. The examination for NSS can offer little information for the evaluation of these children.