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Peer-reviewedCC BY-NC-NDBMC pediatrics

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

  • Angel Miraclin T1
  • Samuel P Oommen2
  • Solomon D Cruz3
  • Karthik Gunasekaran4
  • Manju Joan Inbaraj2
  • Valsan Philip Verghese5
  • Ayyanraj Neeravi3
  • Rosemol Varghese3
  • Feebi Ezekiel4
  • Maya Thomas6
  • Leyanna George7
  • Nivedita Gupta7
1 more authors
  • Balaji Veeraraghavan8
8 affiliations
  1. 1Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
  2. 2Department of Developmental Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
  3. 3Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
  4. 4Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
  5. 5Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India.
  6. 6Department of Paediatric Neurology, Christian Medical College, Vellore, Tamil Nadu, India.
  7. 7Division of Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, India.
  8. 8Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India. [email protected].
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{miraclin2026neurodevelopmental,
  title = {{Neurodevelopmental sequelae in paediatric pneumococcal meningitis: a call for strengthened surveillance and follow-up care.}},
  author = {Angel Miraclin T and Samuel P Oommen and Solomon D Cruz and Karthik Gunasekaran and Manju Joan Inbaraj and Valsan Philip Verghese and Ayyanraj Neeravi and Rosemol Varghese and Feebi Ezekiel and Maya Thomas and Leyanna George and Nivedita Gupta and Balaji Veeraraghavan},
  journal = {BMC pediatrics},
  year = {2026},
  month = aug,
  doi = {10.1186/s12887-026-07438-6},
  url = {https://europepmc.org/article/MED/42958164},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Neurodevelopmental sequelae in paediatric pneumococcal meningitis: a call for strengthened surveillance and follow-up care.
AU  - Angel Miraclin T
AU  - Samuel P Oommen
AU  - Solomon D Cruz
AU  - Karthik Gunasekaran
AU  - Manju Joan Inbaraj
AU  - Valsan Philip Verghese
AU  - Ayyanraj Neeravi
AU  - Rosemol Varghese
AU  - Feebi Ezekiel
AU  - Maya Thomas
AU  - Leyanna George
AU  - Nivedita Gupta
AU  - Balaji Veeraraghavan
PY  - 2026
DA  - 2026/08/01
JO  - BMC pediatrics
DO  - 10.1186/s12887-026-07438-6
UR  - https://europepmc.org/article/MED/42958164
AB  - 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.
SN  - 1471-2431
ER  -