Materiały źródłowe

• #1 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2921388/

  Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age. […] The mortality rate is approximately 5%, and the long-term morbidity, mainly consisting of persistent neurological sequelae, is 15%. Sensorineural hearing loss, seizures, motor problems, hydrocephalus and mental retardation, as well as more subtle outcomes like cognitive, academic and behavioral problems are observed in post-meningitis children.

• #2 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-10-232

  Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age. […] The mortality rate is approximately 5%, and the long-term morbidity, mainly consisting of persistent neurological sequelae, is 15%. […] In pediatric care, the goal must be to prevent these sequelae as much as possible. Therefore, early recognition of children with BM with high risk for the development of sequelae is mandatory.

• #3 Initial therapy and prognosis of community-acquired bacterial meningitis in adults – UpToDate

  https://www.uptodate.com/contents/initial-therapy-and-prognosis-of-community-acquired-bacterial-meningitis-in-adults

  Initial therapy and prognosis of community-acquired bacterial meningitis in adults […] Bacterial meningitis is a medical emergency, and immediate steps must be taken to establish the specific cause and initiate effective therapy. The mortality rate of untreated disease approaches 100 percent, and even with optimal therapy, it is associated with significant morbidity and mortality. […] The initial therapy and prognosis of community-acquired bacterial meningitis will be reviewed here. […] PROGNOSIS […] Mortality […] Neurologic complications […] Prediction of risk

• #4 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2921388/

  In pediatric care, the goal must be to prevent these sequelae as much as possible. Therefore, early recognition of children with BM with high risk for the development of sequelae is mandatory. […] Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studies. […] The presence of these clinical and diagnostic factors in our study demonstrates that severe illness at admission contributes to BM-related mortality and long-term sequelae. In addition, young age was also considered an important prognostic factor. […] Another prognostic factor which we also demonstrated to be related to severity was the causative pathogen of BM. S. pneumoniae seemed to be an important prognostic factor, suggesting a more pathogenic potency of this species in comparison to other bacteria.

• #5 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies | springermedizin.de

  https://www.springermedizin.de/predicting-sequelae-and-death-after-bacterial-meningitis-in-chil/9442100

  Therefore, early recognition of children with BM with high risk for the development of sequelae is mandatory. […] The aim of the present study was to systematically review the available evidence regarding prognostic factors predicting death or sequelae due to BM in children aged 0-18 years in both developing and developed countries. […] We identified 31 studies in the literature on prognostic factors predicting sequelae or death due to BM in children 0-18 years of age. The included studies have presented a large number of potentially important prognostic factors. Only those factors reported in more than one moderate/high quality study were considered as showing some evidence of being important. These factors included several clinical parameters: coma/impaired consciousness, seizures, shock, peripheral circulatory failure, severe respiratory distress, (prolonged) fever and prolonged duration of seizures, which are all signs of severity during the acute phase of the disease.

• #6 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies | springermedizin.de

  https://www.springermedizin.de/predicting-sequelae-and-death-after-bacterial-meningitis-in-chil/9442100

  The presence of these clinical and diagnostic factors in our study demonstrates that severe illness at admission contributes to BM-related mortality and long-term sequelae. […] Another prognostic factor which we also demonstrated to be related to severity was the causative pathogen of BM. S. pneumoniae seemed to be an important prognostic factor, suggesting a more pathogenic potency of this species in comparison to other bacteria. […] Finally, male gender was found as an important prognostic factor, for which we do not have an explanation. All of these factors might be important to assess in children with BM when trying to identify those at the highest risk for the development of sequelae.

• #7 Cryptococcosis in Non-HIV Immunocompromised Hosts: Epidemiology, Pathogenesis, and Management | IntechOpen

  https://www.intechopen.com/online-first/1213803

  In cryptococcosis, serum CrAg is now a well-accepted diagnostic biomarker for detecting or confirming cryptococcal infection; like in HIV patients with cryptococcus infection, high titers herald a poor prognosis. […] Regarding cryptococcus meningitis in non-HIV patients, over the years there have been described significant prognostic factors, including low CSF glucose, high CSF lactate, high CSF cryptococcal antigen titer ( or = 1:1024), initial level of consciousness, the presence of seizure, hydrocephalus, and central nervous system vasculitis. […] Non-HIV immunosuppressed hosts have been noted to have a poorer prognosis. […] In a retrospective study that included 302 patients diagnosed with cryptococcosis between 1996 and 2010, mortality was highest in the NHNT group (27%) vs. SOT (14%) and HIV (20%).

• #8 Treatment outcome and determinant factors of bacterial meningitis at pediatric ward: a multicenter study from Northwest Ethiopia | Scientific Reports

  https://www.nature.com/articles/s41598-025-91340-1

  The study findings indicated that early diagnosis and efficient treatment strategies of comorbid conditions and proper use of combined therapies such as dexamethasone meaningfully improve the treatment outcomes. […] The duration of symptoms plays a substantial role in determining the prognosis compared to the patients who presented to the treatment initiation lately after experiencing symptoms for more than three days duration. […] Those who seek treatment earlier showed good outcomes (Adjusted Odds Ratio (AOR)=4.24, p=0.001) compared to those treated earlier. […] The presence of coexisting diseases was significantly associated with undesirable outcomes (AOR=4.21, p=0.001). […] In addition, dexamethasone administration was also reported as a crucial factor since patients who hadn’t received dexamethasone resulted in poor outcomes (AOR=2.33, p=0.002).

• #9 Cryptococcosis in Non-HIV Immunocompromised Hosts: Epidemiology, Pathogenesis, and Management | IntechOpen

  https://www.intechopen.com/online-first/1213803

  A 12-year review at a tertiary care center (University of Kentucky HealthCare system) included 114 patients with cryptococcosis; 23 (20.2%) had HIV infection, 11 (9.6%) had transplants (nine patients had SOT and two had stem cell transplants), and 80 (70.2%) were NHNT patients. […] Overall, mortality was 28.1% (32/114), and relapse occurred in 10.5% (12/114) of patients. […] The mortality trend was higher (OR = 2.346, p = 0.287) in the transplant group (45.5%, 5/11) than in the HIV (26.1%, 6/23) and NHNT groups (26.3%, 21/80). […] Chronic liver disease had a large and statistically significant association with mortality on multivariate analysis (OR = 3.583, p = 0.013), which was more pronounced than the HIV or transplant groups.

• #10 Cryptococcosis in Non-HIV Immunocompromised Hosts: Epidemiology, Pathogenesis, and Management | IntechOpen

  https://www.intechopen.com/online-first/1213803

  On univariate analyses, prognostic factors positively associated with 90-day mortality included cancer (P = 0.018), fever (P = 0.031), altered mental status (P = 0.001), positive blood cultures (P 0.001), and high (1:512) serum CrAg (P = 0.021). […] In multivariable logistic regression analyses, cryptococcemia [odds ratio (OR) 5.09, 95% confidence interval (CI) 2.5410.22; P 0.001], baseline opening pressure of 25 cm H2O (OR 2.93, 95% CI 1.256.88; P = 0.013), and altered mental status (OR 1.96, 95% CI 0.983.91; P = 0.057) were associated with increased odds of mortality. […] Another retrospective study included 28 confirmed cryptococcal infections between 2005 and 2017. […] The case fatality rate was highest among patients with underlying hematologic malignancies (63%), followed by SOT (50%) and HIV patients (20%).

• #11 Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39117411/

  Objectives: Diagnostic prediction models exist to assess the probability of bacterial meningitis (BM) in paediatric patients with suspected meningitis. To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we performed external validation. […] Results: In total, 23 prediction models were validated in a cohort of 450 patients suspected of a CNS infection included between 2012 and 2015. In 75 patients (17%), the final diagnosis was a CNS infection including 30 with BM (7%). AUCs ranged from 0.69 to 0.94 (median 0.83, interquartile range [IQR] 0.79-0.87) overall, from 0.74 to 0.96 (median 0.89, IQR 0.82-0.92) in children aged 28 days and from 0.58 to 0.91 (median 0.79, IQR 0.75-0.82) in neonates. […] Conclusions: Prediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing.

• #12 Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study | BMJ Open

  https://bmjopen.bmj.com/content/14/8/e081172

  Bacterial meningitis (BM) in children is lethal and debilitating, with mortality rates between 4% and 21% and neurological sequelae occurring in up to one-third of survivors. Early start of treatment is crucial for the prognosis as delay in antibiotic treatment is associated with adverse outcomes. […] Prediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing. […] We validated 23 clinical and laboratory-based diagnostic prediction models for bacterial meningitis, identified in a systematic review, using a cohort of 450 children with a suspected CNS infection. Quality of the included studies varied widely regarding study design, statistical analyses and reporting on model-building procedures. Discrimination was excellent in two models and good in 6 out of 13 models (4 out of 13 in neonates). Calibration showed relevant overestimation or underestimation of BM by all models. However, a sensitivity of 100% is required for implementation in clinical care due to the devastating consequences of missing this disease. Therefore, the results of these prediction models should always be incorporated with all information from the patients history, physical examination and ancillary investigations, and although some of these models provide valuable diagnostic information, they should not be used as a stand-alone test. […] To date, a large amount of prediction models for BM have been developed but none showed excellent discrimination and calibration when validated in a broader population of all patients suspected of a CNS infection.

• #13 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2921388/

  The main concern about the interpretation of the prognostic factors is the fact that due to limited quality of the included studies and heterogeneity of the data it is impossible to perform a meta-analysis and to construct an overall prediction model. […] Several plausible and important prognostic factors for the prediction of sequelae or mortality after BM in childhood were proposed. Because of the limited quality of most studies and the heterogeneous nature of study characteristics and results, findings must be interpreted critically and the prognostic factors found may be used only with caution. This demonstrates that more high quality prognostic studies on factors related to sequelae or death after BM in childhood are clearly needed.

• #14 Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-10-232

  Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studies. […] We identified 31 studies in the literature on prognostic factors predicting sequelae or death due to BM in children 0-18 years of age. The included studies have presented a large number of potentially important prognostic factors. […] Several plausible and important prognostic factors for the prediction of sequelae or mortality after BM in childhood were proposed. Because of the limited quality of most studies and the heterogeneous nature of study characteristics and results, findings must be interpreted critically and the prognostic factors found may be used only with caution. This demonstrates that more high quality prognostic studies on factors related to sequelae or death after BM in childhood are clearly needed.

• #15 Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis | BMC Pulmonary Medicine | Full Text

  https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-019-0966-8

  Tuberculous meningitis is the most devastating presentation of disease with Mycobacterium tuberculosis. We sought to evaluate treatment outcomes for adult patients with this disease. In a pooled analysis, the risk of death was 24.7% (95%CI: 18.731.9). The risk of neurological sequelae among survivors was 50.9% (95%CI: 40.261.5). Patients diagnosed in stage III or human immunodeficiency virus (HIV) positive were significantly more likely to die (64.8, 53.4% respectively) during treatment. Despite anti-tuberculosis treatment, adult tuberculous meningitis has very poor outcomes. The mortality rate of patients diagnosed in stage III or HIV co-infection increased significantly during treatment. Early diagnosis, prompt anti-tuberculosis treatment and corticosteroids are the main determinants of outcome in tuberculous meningitis. A previous systematic review of research showed that the prognosis of tuberculous meningitis in children are very poor, especially for patients in stage III. Our primary objective was to establish risks of death in adult tuberculous meningitis patients during treatment. The findings suggested that the treatment outcomes for adult patients with tuberculous meningitis are poor. More importantly, our subgroup analyses indicated that mortality increased with the severity of the disease. The more serious the disease was, the worse the treatment outcome was. Furthermore, tuberculous meningitis patients who were HIV positive had higher mortality. The high mortality in stage III and HIV co-infection among tuberculous meningitis patients also suggested that the severity of tuberculous meningitis and HIV co-infection are associated with treatment outcome. Treatment outcomes for adult tuberculous meningitis are very poor, especially for patients diagnosed in stage III or HIV co-infection.

• #16 Personalised risk prediction tools for cryptococcal meningitis mortality to guide treatment stratification; a pooled analysis of two randomised-controlled trials | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.07.10.24310212v1.full-text

  Cryptococcal meningitis is a leading cause of adult community-acquired meningitis in sub-Saharan Africa with high mortality rates in the first 10 weeks post diagnosis. Practical tools to stratify mortality risk may help to tailor effective treatment strategies. […] We developed two models, basic and research, to enable use in both resource-limited and research settings (where additional prognostic markers such as measurements of cerebrospinal fluid (CSF) opening pressure and CSF fungal burden may also be available). […] Both models accurately predict mortality, were generalisable across African trial settings, and have potential to be incorporated into future treatment stratification approaches in low and middle-income settings. […] The personalised risk predictor for cryptococcal meningitis (PERISKOPE-CM) models accurately predicted mortality risk among patients with HIV-associated cryptococcal meningitis and demonstrated generalisable performance across trial settings in Africa. Predictions from the models could be utilised to direct treatment stratification approaches in future clinical trials, with patients at lowest predicted risk receiving less intensive and less toxic therapy.

• #17

  https://link.springer.com/article/10.1007/s00431-024-05788-w

  The purpose of this study is to evaluate childhood bacterial meningitis (BM): incidence, clinical presentation, causative pathogens, diagnostics, and outcome (neurological sequelae, hearing loss, and death). […] Neurological sequelae at discharge were present in 24 (34%) patients, unfavourable outcome in 19 (25%), and hearing loss (deafness) in two (3%) survivors of BM. […] Long-term neurological sequelae were observed in 19/60 (32%), aphasia/dysphasia being the most common in 10 (17%) BM children. […] The risk for a fatal course of BM is still remarkable. Neurological sequelae persisted in a substantial proportion of BM survivors in long-term follow-up, aphasia/dysphasia being the most common. Hearing loss (deafness) occurred in 3%. However, no specific risk factors predicting the long-term sequelae were found.

• #18

  https://link.springer.com/article/10.1007/s00431-024-05788-w

  In high-income countries, the fatality rate is approximately 3-10% and survivors of BM have a high risk for long-term disabling neurological sequelae, with estimates varying from 20 to 50%. […] Long-term neurological sequelae were common in our series, being present in 32% of BM survivors. […] The most common long-term neurological sequelae were aphasia/dysphasia, followed by learning difficulties and isolated hypotonia/motor delay. […] The incidence of hearing loss (3%) in our study was lower compared with previous reports, where it has been the most common neurological sequela (14-35%). […] This study highlights the high fatality risk in childhood BM. Furthermore, long-term neurological sequelae persist among BM survivors, with aphasia/dysphasia being the most common. The incidence of profound hearing loss was 3%.

• #19 Treatment outcome and determinant factors of bacterial meningitis at pediatric ward: a multicenter study from Northwest Ethiopia | Scientific Reports

  https://www.nature.com/articles/s41598-025-91340-1

  The study results exhibited that the majority of the patients showed improvement to their treatment indicated, but still a significant portion of patients required antibiotic regimens changes or poor outcomes and lengthy recovery times, which highlights the necessity for tailored therapeutic approaches. […] The finding verdicts also highlighted the significance of early intervention, comprehensive treatment approaches, and evidence-based treatment strategies to augment patient outcomes in meningitis treatment.

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