Open Access Research article

Cognitive deficits following exposure to pneumococcal meningitis: an event-related potential study

Michael Kihara1*, Michelle de Haan2, Eugene O Were13, Harrun H Garrashi1, Brian GR Neville4 and Charles RJC Newton145

Author Affiliations

1 The Centre for Geographical Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya

2 Developmental Cognitive Neuroscience Unit, University College London Institute of Child Health, London, UK

3 Department of Paediatrics, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya

4 Neurosciences Unit, University College London Institute of Child Health, The Wolfson Centre, London, UK

5 London School of Hygiene and Tropical Medicine (LSHTM), London, UK

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BMC Infectious Diseases 2012, 12:79  doi:10.1186/1471-2334-12-79

Published: 31 March 2012



Pneumococcal meningitis (PM) is a severe and life-threatening disease that is associated with cognitive impairment including learning difficulties, cognitive slowness, short-term memory deficits and poor academic performance. There are limited data on cognitive outcomes following exposure to PM from Africa mainly due to lack of culturally appropriate tools. We report cognitive processes of exposed children as measured by auditory and visual event-related potentials.


Sixty-five children (32 male, mean 8.4 years, SD 3.0 years) aged between 4-15 years with a history of PM and an age-matched control group of 93 children (46 male; mean 8.4 years, SD 2.7 years) were recruited from a well-demarcated study area in Kilifi. In the present study, both baseline to peak and peak-to-peak amplitude differences are reported.


Children with a history of pneumococcal meningitis had significantly longer auditory P1 and P3a latencies and smaller P1 amplitudes compared to unexposed children. In the visual paradigm, children with PM seemingly lacked a novelty P3a component around 350 ms where control children had a maximum, and showed a lack of stimulus differentiation at Nc. Further, children with exposure to PM had smaller peak to peak amplitude (N2-P1) compared to unexposed children.


The results suggest that children with a history of PM process novelty differently than do unexposed children, with slower latencies and reduced or absent components. This pattern suggests poorer auditory attention and/or cognitive slowness and poorer visual attention orienting, possibly due to disruption in the functions of the lateral prefrontal and superior temporal cortices. ERPs may be useful for assessment of the development of perceptual-cognitive functions in post brain-injury in African children by providing an alternate way of assessing cognitive development in patient groups for whom more typical standardized neuropsychological assessments are unavailable.