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Herrmann BW, Goff SH, Boguniewicz J, Gitomer SA. Postmeningitic pediatric hearing loss from non-type b Haemophilus influenzae. Am J Otolaryngol 2024; 45:104104. [PMID: 37948823 PMCID: PMC10841718 DOI: 10.1016/j.amjoto.2023.104104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Postmeningitic hearing loss from Haemophilus influenzae (H. influenzae) is increasingly due to encapsulated serotypes other than type b (Hib) and nontypeable strains (collectively, nHiB H. influenzae). Pediatric hearing loss after nHib H. influenzae meningitis remains poorly described. METHODS Retrospecive case series of nHiB H. influenzae meningitis cases identified from a microbiologic database at Children's Hospital Colorado from 2000 to 2020. Literature regarding nHiB H. influenzae and H. influenzae postmeningitic hearing loss was also reviewed. RESULTS Eleven cases of nHib H. influenzae meningitis (median age 15.9 months) were identified due to serotype f (36 %), serotype a (27 %), and nontypable strains (36 %). Seven (64 %) patients were male, 55 % were white and 18 % were Hispanic or Latino. Hearing loss was initially identified in 4 children (40 %), with two patients with moderate conductive hearing loss (CHL) and one child with unilateral moderate sensorineural (SNHL) hearing loss patients recovering normal hearing. One patient with bilateral profound sensorineural hearing loss and associated labyrinthitis ossificans required cochlear implantation. All children (4) with identified hearing loss were noted to have additional intracranial sequelae, which included empyema (2), sinus thrombosis (2), and seizures (2). Of patients receiving steroids, 25 % had hearing loss on initial testing, compared to 66 % of those who did not receive steroids. CONCLUSIONS nHib H. influenzae can cause both transient and permanent postmeningitic hearing loss. Steroids may offer otoprotection in nHib H. influenzae meningitis similar to Hib meningitis. Given the limited literature, further study is needed to better characterize hearing outcomes after nHib H. influenzae meningitis.
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Affiliation(s)
- Brian W Herrmann
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States of America; Children's Hospital Colorado, United States of America.
| | - Salina H Goff
- University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Juri Boguniewicz
- Children's Hospital Colorado, United States of America; Department of Pediatrics - Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Sarah A Gitomer
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States of America; Children's Hospital Colorado, United States of America.
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Lempinen L, Laulajainen‐Hongisto A, Aarnisalo AA, Bernardino L, Peltola H, Pitkäranta A, Pelkonen T, Jero J. Hearing impairment in Angolan children with acute bacterial meningitis with and without otitis media. Acta Paediatr 2022; 111:1585-1593. [PMID: 35500132 DOI: 10.1111/apa.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
AIM Bacterial meningitis (BM) is a common cause of hearing loss in childhood. Our aim was to investigate bacterial aetiology, hearing impairment and outcome in childhood BM with vs. without otitis media (OM) in Angola. METHODS Hearing was tested by auditory brainstem response in 391 (76%) children with confirmed BM. The bacteria identified from the ear discharge were compared to those from cerebrospinal fluid (CSF). The hearing findings were compared among children with vs. without OM on days 1 and 7 of hospitalization, and at follow-ups of 1, 3 and 6 month(s). RESULTS No correlation was found in bacteriology between the ear discharge and CSF. On day 7 in hospital, hearing impairment (>40 dB) was common, regardless of whether concomitant OM or not (in 27% vs. 30%, respectively). Any hearing deficit on day 7 was associated with a higher risk of complicated or fatal clinical course (OR 2.76, CI95% 1.43-5.29, p = 0.002). CONCLUSION No significant difference prevailed in hearing thresholds between children with or without OM in hospital on day 7 or at later follow-ups. Any hearing impairment during hospital stay associated with a higher risk for complicated clinical course or death.
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Affiliation(s)
- Laura Lempinen
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anu Laulajainen‐Hongisto
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Antti A. Aarnisalo
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Heikki Peltola
- Children’s Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology, Head and Neck Surgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Tuula Pelkonen
- Pediatric Hospital David Bernardino Luanda Angola
- Children’s Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jussi Jero
- University of Helsinki and Helsinki University Hospital Helsinki Finland
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Bacterial Meningitis in Children: Neurological Complications, Associated Risk Factors, and Prevention. Microorganisms 2021; 9:microorganisms9030535. [PMID: 33807653 PMCID: PMC8001510 DOI: 10.3390/microorganisms9030535] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 01/07/2023] Open
Abstract
Bacterial meningitis is a devastating infection, with a case fatality rate of up to 30% and 50% of survivors developing neurological complications. These include short-term complications such as focal neurological deficit and subdural effusion, and long-term complications such as hearing loss, seizures, cognitive impairment and hydrocephalus. Complications develop due to bacterial toxin release and the host immune response, which lead to neuronal damage. Factors associated with increased risk of developing neurological complications include young age, delayed presentation and Streptococcus pneumoniae as an etiologic agent. Vaccination is the primary method of preventing bacterial meningitis and therefore its complications. There are three vaccine preventable causes: Haemophilus influenzae type b (Hib), S. pneumoniae, and Neisseria meningitidis. Starting antibiotics without delay is also critical to reduce the risk of neurological complications. Additionally, early adjuvant corticosteroid use in Hib meningitis reduces the risk of hearing loss and severe neurological complications.
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Perny M, Solyga M, Grandgirard D, Roccio M, Leib SL, Senn P. Streptococcus pneumoniae-induced ototoxicity in organ of Corti explant cultures. Hear Res 2017; 350:100-109. [PMID: 28460251 DOI: 10.1016/j.heares.2017.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/11/2017] [Accepted: 04/23/2017] [Indexed: 12/20/2022]
Abstract
Hearing loss remains the most common long-term complication of pneumococcal meningitis (PM) reported in up to 30% of survivors. Streptococcus pneumoniae have been shown to possess different ototoxic properties. Here we present a novel ex vivo experimental setup to examine in detail the pattern of hair cell loss upon exposure to different S. pneumoniae strains, therefore recapitulating pathogen derived aspects of PM-induced hearing loss. Our results show a higher susceptibility towards S. pneumoniae-induced cochlear damage for outer hair cells (OHC) compared to inner hair cells (IHC), which is consistent with in vivo data. S. pneumoniae-induced hair cell loss was both time and dose-dependent. Moreover, we have found significant differences in the level of cell damage between tissue from the basal and the apical turns. This shows that the higher vulnerability of hair cells located at high frequency regions observed in vivo cannot be explained solely by the spatial organisation and bacterial infiltration from the basal portion of the cochlea. Using a wild type D39 strain and a mutant defective for the pneumolysin (PLY) gene, we also have shown that the toxin PLY is an important factor involved in ototoxic damages. The obtained results indicate that PLY can cause both IHC and OHC loss. Finally, we are reporting here for the first time a higher vulnerability of HC located at the basal and middle cochlear region to pneumolysin-induced damage. The detailed description of the susceptibility of hair cells to Streptococcus pneumoniae provided in this report can in the future determine the choice and the development of novel otoprotective therapies during pneumococcal meningitis.
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Affiliation(s)
- Michael Perny
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Switzerland; Inner Ear Research Laboratory, Department of Otorhinolaryngology, Head& Neck Surgery, Inselspital Bern and Department of Clinical Research, University of Bern, Switzerland; Cluster for Regenerative Neuroscience, Department of Clinical Research, University of Bern, Switzerland
| | - Magdalena Solyga
- Inner Ear Research Laboratory, Department of Otorhinolaryngology, Head& Neck Surgery, Inselspital Bern and Department of Clinical Research, University of Bern, Switzerland; Cluster for Regenerative Neuroscience, Department of Clinical Research, University of Bern, Switzerland
| | - Denis Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Switzerland; Cluster for Regenerative Neuroscience, Department of Clinical Research, University of Bern, Switzerland
| | - Marta Roccio
- Inner Ear Research Laboratory, Department of Otorhinolaryngology, Head& Neck Surgery, Inselspital Bern and Department of Clinical Research, University of Bern, Switzerland; Cluster for Regenerative Neuroscience, Department of Clinical Research, University of Bern, Switzerland
| | - Stephen L Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Switzerland; Cluster for Regenerative Neuroscience, Department of Clinical Research, University of Bern, Switzerland.
| | - Pascal Senn
- Inner Ear Research Laboratory, Department of Otorhinolaryngology, Head& Neck Surgery, Inselspital Bern and Department of Clinical Research, University of Bern, Switzerland; Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Geneva (HUG), Genève, Switzerland; Cluster for Regenerative Neuroscience, Department of Clinical Research, University of Bern, Switzerland.
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van de Beek D, Brouwer M, Hasbun R, Koedel U, Whitney CG, Wijdicks E. Community-acquired bacterial meningitis. Nat Rev Dis Primers 2016; 2:16074. [PMID: 27808261 DOI: 10.1038/nrdp.2016.74] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. It can be acquired spontaneously in the community - community-acquired bacterial meningitis - or in the hospital as a complication of invasive procedures or head trauma (nosocomial bacterial meningitis). Despite advances in treatment and vaccinations, community-acquired bacterial meningitis remains one of the most important infectious diseases worldwide. Streptococcus pneumoniae and Neisseria meningitidis are the most common causative bacteria and are associated with high mortality and morbidity; vaccines targeting these organisms, which have designs similar to the successful vaccine that targets Haemophilus influenzae type b meningitis, are now being used in many routine vaccination programmes. Experimental and genetic association studies have increased our knowledge about the pathogenesis of bacterial meningitis. Early antibiotic treatment improves the outcome, but the growing emergence of drug resistance as well as shifts in the distribution of serotypes and groups are fuelling further development of new vaccines and treatment strategies. Corticosteroids were found to be beneficial in high-income countries depending on the bacterial species. Further improvements in the outcome are likely to come from dampening the host inflammatory response and implementing preventive measures, especially the development of new vaccines.
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Affiliation(s)
- Diederik van de Beek
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, P.O. BOX 22660, 1100DD Amsterdam, The Netherlands
| | - Matthijs Brouwer
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, P.O. BOX 22660, 1100DD Amsterdam, The Netherlands
| | - Rodrigo Hasbun
- Department of Internal Medicine, UT Health McGovern Medical School, Houston, Texas, USA
| | - Uwe Koedel
- Department of Neurology, Clinic Grosshadern of the Ludwig-Maximilians University of Munich, Munich, Germany
| | - Cynthia G Whitney
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eelco Wijdicks
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Lucas MJ, Brouwer MC, van de Beek D. Neurological sequelae of bacterial meningitis. J Infect 2016; 73:18-27. [PMID: 27105658 DOI: 10.1016/j.jinf.2016.04.009] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We reported on occurrence and impact of neurological sequelae after bacterial meningitis. METHODS We reviewed occurrence of neurological sequelae in children and adults after pneumococcal and meningococcal meningitis. RESULTS Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Adults with pneumococcal meningitis have the highest risk of developing focal neurological deficits, which are most commonly caused by cerebral infarction, but can also be due to cerebritis, subdural empyema, cerebral abscess or intracerebral bleeding. Focal deficits may improve during clinical course and even after discharge, but a proportion of patients will have persisting focal neurological deficits that often interfere in patient's daily life. Hearing loss occurs in a high proportion of patients with pneumococcal meningitis and has been associated with co-existing otitis. Children and adults recovering from bacterial meningitis without apparent neurological deficits are at risk for long-term cognitive deficits. Early identification of neurological sequelae is important for children to prevent additional developmental delay, and for adults to achieve successful return in society after the disease. CONCLUSIONS Neurological sequelae occur in a substantial amount of patients following bacterial meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy.
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Affiliation(s)
- Marjolein J Lucas
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands.
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