GBS meningitis has long-lasting effects

Significant numbers of infants who survive meningitis caused by group B Streptococcus (GBS) suffer long-term adverse outcomes such as developmental delay, academic underachievement, neurologic impairment, blindness, hearing loss, and cerebral palsy, a new study reports.

Researchers evaluated 43 survivors of GBS meningitis aged 3 to 12 years (mean age, 6.8 years) using physical and neurologic examinations, hearing and vision screens, and standardized developmental assessments (Mullen Scales of Early Learning and Wechsler Individual Achievement Test, second edition [WIAT-II]). Eleven (25%) children had mild-to-moderate impairment; 8 (19%) had severe disabilities. Twenty-four (56%) showed age-appropriate development and no detectable sequelae.

Of the 11 mild or moderately affected children, 9 had Mullin or WIAT-II scores reflecting mild to moderate cognitive impairment; 3 had repeated 1 or more grades in school; 3 had a persistent asymptomatic seizure disorder; 1 had hydrocephalus requiring a ventriculoperitoneal shunt; and 1 had lost the terminal digits of his right thumb and forefinger to purpura fulminans in the hospital.

All 8 of the severely impaired children had profound global developmental delay; 2 had hydrocephalus; 4 had cortical visual impairment; 4 had bilateral sensorineural deafness; 5 had cerebral palsy or spasticity; and 4 had persistent symptomatic seizures.

Infants with certain characteristics on admission to and discharge from the hospital had an increased risk of postdischarge death or severe disability. Admission features included lethargy, respiratory distress, coma or semicoma, seizures, bulging fontanel, leukopenia, acidosis, cerebrospinal fluid protein more than 300 mg/dL, cerebrospinal fluid glucose less than 20 mg/dL, and need for ventilator or vasopressor support.

Discharge findings included a failed hearing screen or abnormal neurologic examination or brain imaging at the end of treatment. Admission and discharge data did not predict mild to moderate impairment or normal functioning.

The researchers emphasize the need for developmental follow-up of children who survive GBS meningitis and preventive strategies such as developing glycoconjugate vaccine for mothers to prevent infection.

Group B Streptococcus accounts for 86.1% of bacterial meningitis in children younger than 2 months, according to the Emerging Infections Programs Network of the Centers for Disease Control and Prevention.

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