2024-01-19 カロリンスカ研究所(KI)
◆感染は抗生物質で治療可能だが、多くの場合、恒久的な神経損傷を引き起こす。特に子供が影響を受けることが多く、その結果は大きな負担となる。
◆スウェーデンの細菌性髄膜炎のデータを分析し、感染した子供約3,500人と対照群32,000人以上を比較。感染者は一貫して認知機能障害、発作、視力や聴力の障害、運動機能障害、行動障害、頭部の構造的損傷などの神経障害の有病率が高かった。感染者の約3分の1が少なくとも1つの神経障害を抱えており、これは対照群の約10分の1に比べている。感染が治癒されても、多くの人が神経障害を抱えていることが示され、今後は治療法の開発が進められる見込み。
<関連情報>
- https://news.ki.se/bacterial-meningitis-damages-one-in-three-children-for-life
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814090
スウェーデンにおける小児細菌性髄膜炎後の長期障害リスクの増加 Increased Risk of Long-Term Disabilities Following Childhood Bacterial Meningitis in Sweden
Salini Mohanty, DrPH; Urban Johansson Kostenniemi,
JAMA Network Open Published:January 19, 2024
DOI:10.1001/jamanetworkopen.2023.52402
Key Points
Question What is the long-term risk of disabilities among individuals diagnosed with bacterial meningitis in childhood?
Findings In a cohort study of 36 230 participants with up to 35 years of follow-up, those diagnosed with bacterial meningitis in childhood between 1987 and 2021 had a significantly higher risk of developing 7 neurological disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) relative to general population controls matched on age, sex, and place of residence.
Meaning These findings suggest that individuals in Sweden diagnosed with bacterial meningitis in childhood have an increased risk of long-term disabilities.
Abstract
Importance Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort.
Objective To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden.
Design, Setting, and Participants This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023.
Exposure A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021.
Main Outcomes and Measures Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood.
Results The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median.
Conclusions and Relevance The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.
