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.