Complications
Reported in about 15% of children with pneumococcal meningitis.[76]
Features include:
Capillary refill time >2 seconds[2]
Abnormal skin colour[2]
Tachycardia and/or hypotension[2]
Respiratory symptoms or breathing difficulty[2]
Cold hands/feet[2]
Toxic/moribund state[2]
Altered mental state/decreased conscious level[2]
Poor urine output[2]
Hypoxia on arterial blood gas[26]
Base deficit (worse than -5 mmol/L)[26]
Increased lactate (>2 mmol/L)[26]
Lumbar puncture is contraindicated in patients with suspected raised ICP.[2]
Signs of raised ICP include:[4][28]
Reduced or fluctuating level of consciousness (Glasgow Coma Scale score <0 or drop of ≥3) [ Glasgow Coma Scale Opens in new window ]
In children unable to give a verbal response (in practice, those under 2 years), use the Glasgow Coma Scale with modification for children[2] Glasgow Coma Scale: modification for children Opens in new window
Relative bradycardia and hypertension
Focal neurological signs
Abnormal posture or posturing
Seizures
Unequal, dilated, or poorly responsive pupils
Papilloedema (late sign)
An enlarged blind spot may be identified when you examine the visual fields
Abnormal ‘doll’s eye’ movements.
Caused by local inflammatory responses to bacteria, altered cerebral blood flow, and vasculitis, which lead to cerebral oedema.
Follow local or national protocols to treat raised intracranial pressure.[2]
Occur in:
9% to 34% of neonates with bacterial meningitis.[3][4] More common with group B streptococci than Escherichia coli.[3]
10% to 56% of children with bacterial meningitis.[3][32][34][36][37] More common with Streptococcus pneumoniae and Haemophilus influenzae type b than Neisseria meningitidis.[5]
Follow local or national protocols to treat seizures in children and young people with suspected bacterial meningitis.[2]
A potential complication of bacterial meningitis, particularly in neonates and gram-negative meningitis.
Subtle consequences that may not be apparent for several years after infection. Around 20% to 30% of children who have had bacterial meningitis go on to develop academic and behavioural problems and 10% to 20% have significant cognitive impairment overall.[62][63][64][65] However, neurological complications are more common in lower- and middle-income countries due to delayed presentation to medical services, lack of access to health care, and limited resources.[65]
Affected children may require multidisciplinary assessment and treatment.
Permanent sensorineural hearing loss occurs in 5% to 10% of all patients after bacterial meningitis of any aetiology and in up to 30% of those with pneumococcal meningitis.[58][77][78] However, hearing loss is more common in lower- and middle-income countries due to delayed presentation to medical services, lack of access to health care, and limited resources.[65]
Ensure children and young people are reviewed by a paediatrician (with the results of their hearing test) 4-6 weeks after hospital discharge to discuss morbidities associated with their condition and be offered referral to appropriate services.[2] Children with hearing loss are at risk of further developing balance disturbances and speech and language delay, which can lead to long-term behavioural problems.[79][80]
Cranial nerve palsies (including III, IV, VI, and VII nerves) can occur in meningitis due to brain swelling or adjacent meningeal inflammatory reaction. Cranial nerve deficits related to meningitis are usually transient.
Motor deficits, such as hemiparesis or quadriparesis, can also complicate bacterial meningitis and generally improve with time.
Focal neurological deficits are more common following pneumococcal meningitis compared with meningococcal meningitis.[65] Focal neurological deficits are also more common in lower- and middle-income countries compared with high-income countries. This is thought to be due to delayed presentation to medical services, lack of access to health care, and limited resources in lower-income countries.[65]
While rare overall, brain abscesses (epidural, subdural, intracerebral) may occur more frequently in children with meningitis due to unusual organisms.
Consider in patients with an impaired level of consciousness, seizures, fluctuating focal signs, and stroke.
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