Cognitive and Neurological Complications of Meningitis at Abbassia Fever Hospital
Alhassan Ouda Attia Ghodeif;
Abstract
A
cute infections of the nervous system are among the most important problems in medicine because early recognition, efficient decision-making, and rapid institution of therapy can be lifesaving.
Worldwide, it has been estimated that 1-2 million cases of bacterial meningitis occur annually. Despite advances in medical care, the introduction of cranial CT and improvements in intensive care support, the mortality from bacterial meningitis remains high. Survivors of bacterial meningitis are at risk from long-term disabling sequelae and impaired quality of life. There is little information about the severity and distribution of the different types of sequelae. Data are especially poor from low-income countries.
Mortality and serious long-term sequelae still occur in about 50% of patients with tuberculous meningitis. Fungal meningitis is a serious disease caused by a fungal infection of the central nervous system (CNS) mostly in individuals with immune system deficiencies.
The present study was designed to assess the different cognitive and neurological complications in patients with meningitis. The study included 63 patients diagnosed with meningitis and presented to Abbassia fever hospital. All patients were evaluated on admission but on discharge 22 patients died and they were not evaluated at discharge.
All the included patients were subjected to the following:
1- Full medical history taking and clinical examination.
2- Full neurological examination
3- Laboratory investigations, CSF analysis and imaging studies.
4- Assessment of cognitive function on discharge using the mini mental state examination (MMSE) and Wechsler memory scale (WMS).
5- Assessment of outcome of patients using the Glasgow outcome scale (GOS), patients were ranked from 1 to 5. Outcome was classified into poor (GOS: 1-4) and good (GOS=5)
The results of the present study, showed male predominance with male to female ratio was 2.3:1. Patients' age ranged from 16 to 80 years but younger age group (16-40 years) was the most representing group. Patients were affected over the whole year but the majority of patients were presented in summer season.
Patients' diagnosis varied, 45 patients were diagnosed as bacterial meningitis, 16 patients as TB meningitis and 2 patients as fungal meningitis. Among patients diagnosed as bacterial meningitis CSF culture was positive for Pneumococci in 6.7% and E.coli in 4.4% 0f bacterial meningitis cases while 88.9 % were culture negative.
Clinical features of patients on admission were principally fever, headache, DCL and vomiting. Neurological examination of patients on admission revealed that DCL, disorders of sphincter control, neck rigidity and stretch signs were most evident.
There was a highly significant relationship between diagnosis and cell count in CSF (p <0.01). There were no significant relation between diagnosis and other CSF parameters.
The main systemic complications were hospital acquired infection, Hyponatremia, sepsis and organ failure. The main causes of death were sepsis and organ failure.
Neurological complications detected on discharge in bacterial meningitis and TB meningitis were mainly ischemic brain insult, cranial nerve damage and hearing impairment. The results revealed no significant relationship between neurological complications in relation to age groups, diagnosis or MRI picture
The MMSE revealed that 47% of tested bacterial meningitis patients and 63% of tested TB meningitis patients had cognitive impairment. Wechsler memory scale revealed that mainly impaired memory functions in tested patients were mental control (58.5%), orientation (46.3%), information (41.5%), and logical memory (34.1%).
The results revealed no significant relationship between impairment of different cognitive functions compared to age or diagnosis.
In the present study, 31.7% of studied patients had good outcome while 68.3% of them had poor outcome. Multiple regression analysis revealed that duration until diagnosis, intracranial complications, need for mechanical ventilation and drug abuse (other than IV) are significant predictors of worse outcome. There was significant correlation between pneumococcal meningitis and outcome (t= -1.87, P<0.05).
Recurrent meningitis was identified in 10 cases, their etiology was principally due to local causes. There was significant relationship (P <0.05) between outcome and recurrence, patients with recurrent meningitis had better outcome (mean=4.2).
cute infections of the nervous system are among the most important problems in medicine because early recognition, efficient decision-making, and rapid institution of therapy can be lifesaving.
Worldwide, it has been estimated that 1-2 million cases of bacterial meningitis occur annually. Despite advances in medical care, the introduction of cranial CT and improvements in intensive care support, the mortality from bacterial meningitis remains high. Survivors of bacterial meningitis are at risk from long-term disabling sequelae and impaired quality of life. There is little information about the severity and distribution of the different types of sequelae. Data are especially poor from low-income countries.
Mortality and serious long-term sequelae still occur in about 50% of patients with tuberculous meningitis. Fungal meningitis is a serious disease caused by a fungal infection of the central nervous system (CNS) mostly in individuals with immune system deficiencies.
The present study was designed to assess the different cognitive and neurological complications in patients with meningitis. The study included 63 patients diagnosed with meningitis and presented to Abbassia fever hospital. All patients were evaluated on admission but on discharge 22 patients died and they were not evaluated at discharge.
All the included patients were subjected to the following:
1- Full medical history taking and clinical examination.
2- Full neurological examination
3- Laboratory investigations, CSF analysis and imaging studies.
4- Assessment of cognitive function on discharge using the mini mental state examination (MMSE) and Wechsler memory scale (WMS).
5- Assessment of outcome of patients using the Glasgow outcome scale (GOS), patients were ranked from 1 to 5. Outcome was classified into poor (GOS: 1-4) and good (GOS=5)
The results of the present study, showed male predominance with male to female ratio was 2.3:1. Patients' age ranged from 16 to 80 years but younger age group (16-40 years) was the most representing group. Patients were affected over the whole year but the majority of patients were presented in summer season.
Patients' diagnosis varied, 45 patients were diagnosed as bacterial meningitis, 16 patients as TB meningitis and 2 patients as fungal meningitis. Among patients diagnosed as bacterial meningitis CSF culture was positive for Pneumococci in 6.7% and E.coli in 4.4% 0f bacterial meningitis cases while 88.9 % were culture negative.
Clinical features of patients on admission were principally fever, headache, DCL and vomiting. Neurological examination of patients on admission revealed that DCL, disorders of sphincter control, neck rigidity and stretch signs were most evident.
There was a highly significant relationship between diagnosis and cell count in CSF (p <0.01). There were no significant relation between diagnosis and other CSF parameters.
The main systemic complications were hospital acquired infection, Hyponatremia, sepsis and organ failure. The main causes of death were sepsis and organ failure.
Neurological complications detected on discharge in bacterial meningitis and TB meningitis were mainly ischemic brain insult, cranial nerve damage and hearing impairment. The results revealed no significant relationship between neurological complications in relation to age groups, diagnosis or MRI picture
The MMSE revealed that 47% of tested bacterial meningitis patients and 63% of tested TB meningitis patients had cognitive impairment. Wechsler memory scale revealed that mainly impaired memory functions in tested patients were mental control (58.5%), orientation (46.3%), information (41.5%), and logical memory (34.1%).
The results revealed no significant relationship between impairment of different cognitive functions compared to age or diagnosis.
In the present study, 31.7% of studied patients had good outcome while 68.3% of them had poor outcome. Multiple regression analysis revealed that duration until diagnosis, intracranial complications, need for mechanical ventilation and drug abuse (other than IV) are significant predictors of worse outcome. There was significant correlation between pneumococcal meningitis and outcome (t= -1.87, P<0.05).
Recurrent meningitis was identified in 10 cases, their etiology was principally due to local causes. There was significant relationship (P <0.05) between outcome and recurrence, patients with recurrent meningitis had better outcome (mean=4.2).
Other data
| Title | Cognitive and Neurological Complications of Meningitis at Abbassia Fever Hospital | Other Titles | المضاعفات المعرفية والعصبية لمرض الالتهاب السحائي بمستشفى حميات العباسية | Authors | Alhassan Ouda Attia Ghodeif | Issue Date | 2014 |
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