LONG-TERM SEQUELAE AFTER SEVERE MENINGOCOCCAL DISEASE; A 8 YEAR FOLLOW-UP

von Rosenstiel IA, Ikhenemoh FA

Department of Pediatric Intensive Care, Emma Children¡¯s Hospital, Academic Medical Center, Amsterdam, The Netherlands

 

Objective: To assess the incidence, type and severity of long-term sequelae after severe meningococcal disease (SMD).

Methods: The outcome of a total of 141 children with SMD and treatment in PICU between Jan. 1993 and Dec. 2000 (age 14 months-18 years) was evaluated. During follow-up a standard questionnaire and physical examination were completed. Sequelae were grouped in 6 main domains and subdivided in mild, moderate and profound. Long-term sequelae were defined as abnormalities at least 12 months after acute disease.

Results: Although 56 children out of 141 survivors showed complete recovery a substantial number of 85 children were diagnosed with physical and/or mental abnormalities related to SMD, yielding a total incidence of 60% long-term sequelae. Frequency of the sequelae in children per domain over the total cohort in descending order: a significant high number of children had neurobehavioral sequelae (21,9%), dermatological sequelae (26,9%), neurological sequelae (24,1%), hearing impairment (7,8%) and amputations and secondary growth disorders (9,2% and 3,5% respectively). 30,5% had multiple sequelae with high neurobehavioral prevalence. In this domain, in particular concentration and mood disorders were significantly meningitis-related (P=0,001). Neurological sequelae included cerebral palsy (n=1), motor and sensibility disorders (n=8), epilepsy (n=3), mental retardation (n=3), speech problems (n=3), visual impairment (n=4) and persistent headache (n=10). 90% of all recorded sequelae were graded mild to moderate. All children were leading a normal functional life, except for 3 (2.1%) being severely disabled.

Conclusion: The high incidence of physical and mental sequelae after SMD, although mostly mild to moderate, underscores the need for structural follow-up, directed at optimal care, secondary prevention and support for survivors of SMD.

 

 
1555