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Background <p>Pneumococcal meningitis remains a significant cause of morbidity and mortality in children, particularly in low- and middle-income countries. Despite widespread use of pneumococcal conjugate vaccines (PCVs), limited data exist from India on the long-term neurodevelopmental sequelae among survivors. This study aimed to characterise the clinical profile, microbiological features, and neurocognitive outcomes of children diagnosed with pneumococcal meningitis over a 15-year period at a tertiary care centre in South India.</p> Methods <p>This cross-sectional study included children admitted with microbiologically confirmed pneumococcal meningitis between January 2007 and January 2022. Clinical, laboratory, radiological, and microbiological data were retrieved retrospectively. Survivors were contacted for follow-up; consenting families underwent structured neurodevelopmental screening and in-person evaluations by a developmental paediatrician and psychologist. Outcomes were assessed using the Modified Rankin Scale (mRS) and domain-specific neuropsychological assessments. Statistical analyses were conducted using SPSS software.</p> Results <p>A total of 48 children were included, of whom 70.8% were male and under 12 months of age. The in-hospital case fatality rate was 10.4%, while 25.7% of children died post-discharge. At follow-up, only 57.2% achieved favourable functional outcomes (mRS 0–2), and 17.2% had moderate-to-severe disability (mRS 3–5). Long-term sequelae included learning difficulties (54.2%), behavioural disturbances (37.5%), intellectual disability (37.5%), hearing impairment (28.0%), and drug-refractory epilepsy (25.0%). Language impairments, sensorimotor delays, executive dysfunction, and cortical visual impairment were also observed. Serotype 14 was the most prevalent (20.8%), with 23 unique serotypes identified. Post-vaccine trends showed a decline in the prevalence of vaccine-protected serotypes, such as 6B and 23&#xa0;F, and the emergence of 19&#xa0;A and 7&#xa0;F. Penicillin resistance was high (79.2%), including 14.6% with high-level resistance (≥ 1&#xa0;µg/mL). Cefotaxime susceptibility remained favourable in 81.3% of isolates; however, increasing resistance is alarming.</p> Conclusion <p>Pneumococcal meningitis in children is associated with substantial mortality and a high burden of long-term neurodevelopmental sequelae, particularly in low-resource settings. Survivors experience persistent deficits across cognitive, motor, sensory, and behavioural domains, warranting structured post-discharge neurodevelopmental follow-up. The evolving serotype landscape and antibiotic resistance patterns underscore the need for continuous surveillance and tailored vaccine strategies, with particular emphasis on PCV13. Public health efforts must integrate early rehabilitation and school-based support to optimise outcomes for children affected by this disease.</p>

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Neurodevelopmental sequelae in paediatric pneumococcal meningitis: a call for strengthened surveillance and follow-up care

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Angel Miraclin T.,
  • Samuel P. Oommen,
  • Solomon D. Cruz,
  • Karthik Gunasekaran,
  • Manju Joan Inbaraj,
  • Valsan Philip Verghese,
  • Ayyanraj Neeravi,
  • Rosemol Varghese,
  • Feebi Ezekiel,
  • Maya Thomas,
  • Leyanna George,
  • Nivedita Gupta,
  • Balaji Veeraraghavan

摘要

Background

Pneumococcal meningitis remains a significant cause of morbidity and mortality in children, particularly in low- and middle-income countries. Despite widespread use of pneumococcal conjugate vaccines (PCVs), limited data exist from India on the long-term neurodevelopmental sequelae among survivors. This study aimed to characterise the clinical profile, microbiological features, and neurocognitive outcomes of children diagnosed with pneumococcal meningitis over a 15-year period at a tertiary care centre in South India.

Methods

This cross-sectional study included children admitted with microbiologically confirmed pneumococcal meningitis between January 2007 and January 2022. Clinical, laboratory, radiological, and microbiological data were retrieved retrospectively. Survivors were contacted for follow-up; consenting families underwent structured neurodevelopmental screening and in-person evaluations by a developmental paediatrician and psychologist. Outcomes were assessed using the Modified Rankin Scale (mRS) and domain-specific neuropsychological assessments. Statistical analyses were conducted using SPSS software.

Results

A total of 48 children were included, of whom 70.8% were male and under 12 months of age. The in-hospital case fatality rate was 10.4%, while 25.7% of children died post-discharge. At follow-up, only 57.2% achieved favourable functional outcomes (mRS 0–2), and 17.2% had moderate-to-severe disability (mRS 3–5). Long-term sequelae included learning difficulties (54.2%), behavioural disturbances (37.5%), intellectual disability (37.5%), hearing impairment (28.0%), and drug-refractory epilepsy (25.0%). Language impairments, sensorimotor delays, executive dysfunction, and cortical visual impairment were also observed. Serotype 14 was the most prevalent (20.8%), with 23 unique serotypes identified. Post-vaccine trends showed a decline in the prevalence of vaccine-protected serotypes, such as 6B and 23 F, and the emergence of 19 A and 7 F. Penicillin resistance was high (79.2%), including 14.6% with high-level resistance (≥ 1 µg/mL). Cefotaxime susceptibility remained favourable in 81.3% of isolates; however, increasing resistance is alarming.

Conclusion

Pneumococcal meningitis in children is associated with substantial mortality and a high burden of long-term neurodevelopmental sequelae, particularly in low-resource settings. Survivors experience persistent deficits across cognitive, motor, sensory, and behavioural domains, warranting structured post-discharge neurodevelopmental follow-up. The evolving serotype landscape and antibiotic resistance patterns underscore the need for continuous surveillance and tailored vaccine strategies, with particular emphasis on PCV13. Public health efforts must integrate early rehabilitation and school-based support to optimise outcomes for children affected by this disease.