Strategies urged to manage morbidity associated with GBS meningitis
Developmental follow-up is needed for infants who survive group B streptococcal meningitis, along with prevention strategies, because this disease is associated with high rates of serious, long-term morbidity, according to recently published study findings.
Romina Libster, MD, of the Vanderbilt Vaccine Research Program at the department of pediatrics at the Vanderbilt University Medical Center in Nashville, and colleagues looked at data on 90 near-term and term infants from two children’s hospitals who were diagnosed with group B streptococcal (GBS) meningitis between 1998 and 2006. Ten of the children died before age 3 years; five deaths were acute and five occurred between the ages of 6 months and 3 years.
Libster and colleagues, including Infectious Diseases in Children Editorial Board member Kathryn M. Edwards, MD, examined data on 43 survivors, and they said 25% of the children had mild-to-moderate impairment and 19% were classified as having severe impairment.
The researchers said symptoms that predicted mortality or long-term morbidity at the time of hospital admission included lethargy; respiratory distress; coma or semi-coma; seizures; bulging fontanel; leucopenia; acidosis; cerebrospinal fluid protein of more than 300 mg/dL; cerebrospinal fluid glucose of less than 20 mg/dL; and a continued need for ventilator or pressor support. The investigators also reported that the features at discharge that were indicative of late death or severe impairment included failure of hearing screening, abnormal neurologic examination and abnormal results of end-of-therapy brain imaging.
“These findings highlight a need for awareness regarding the possibility of deficits at follow-up evaluation that can affect developmental and behavioral futures for these children,” the researchers wrote. “They also underscore the need for prevention strategies, such as development of GBS glycoconjugate vaccines for maternal immunization, to prevent this potentially devastating infection.”
Disclosure: Dr. Edwards reports financial ties to Novartis Vaccines & Diagnostics. Dr. Libster reports no relevant financial disclosures.