Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease

Abstract

ABSTRACT. Objective. To determine the frequency of unsuspected meningococcal disease (UMD) in young febrile children with meningococcal infections and evaluate whether clinical and laboratory parameters commonly used in the evaluation of fever can help identify children with UMD.Methods. We reviewed the records of children with meningococcal disease from 1985 to 1996 at four referral centers. Children who were evaluated as outpatients and then discharged to home, from whom Neisseria meningitidis was isolated from blood or cerebrospinal fluid cultures obtained during these outpatient visits, were considered to have UMD. We compared clinical and laboratory parameters between these children and 6414 febrile outpatients 3 to 36 months old with negative blood cultures enrolled in a separate study of occult bacteremia.Results. We identified 381 children with meningococcal disease, of whom 45 (12%) had UMD. Of the 45 with UMD, 37 (82%) were 3 to 36 months old. Compared with the 6414 culture-negative patients, these 37 patients with UMD were significantly younger (8.9 ؎ 5.4 vs 14.2 ؎ 8.1 months) and had significantly higher band counts (14.3 ؎ 11.1 vs 7.3 ؎ 7.5%). There were no significant differences, however, in temperature, white blood cell counts, and absolute neutrophil counts. Multivariate analysis identified young age and the band count as independent predictors of UMD.Conclusions. Children ultimately diagnosed with meningococcal disease have commonly been evaluated as outpatients and discharged to home before diagnosis. Of the hematologic parameters frequently used in the evaluation of fever, only the band count differs significantly between young febrile children with UMD and those with negative cultures. Because UMD is uncommon in young febrile pediatric outpatients, however, the predictive value of the band count is low. Thus, the complete blood count is not routinely helpful for the diagnosis of UMD. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e20; Neisseria meningitidis, meningococcal infections, bacteremia, complete blood count, neutrophil.

Extremity Pain and Refusal to Walk in Children With Invasive Meningococcal Disease

“…Demographic information (age and gender), clinical characteristics (temperature, rash), and laboratory characteristics (WBC counts, band counts, CSF findings) were described previously in large subgroups of this study population. 3,5,[7][8][9]11 Two percent of the patients had arthritis at presentation. Thirty-six (13%) of the 274 patients had adverse outcomes, and 26 (72%) of these 36 died.…”

“…1,4,6 In the course of reviewing charts of children with invasive meningococcal disease in previous investigations, 5,[7][8][9] we noted that extremity pain and refusal to walk were not uncommon clinical findings at the time of presentation. We considered whether these findings, in association with other nonspecific symptoms, might prompt clinicians to consider the diagnosis of invasive meningococcal disease in the evaluation of a febrile child.…”

“…[5][6][7] Although early recognition and treatment of meningococcal disease decreases complications, 7 neither the physical examination nor the hematologic evaluation reliably enables health care providers to differentiate these children from those with other, less serious illnesses. 5 The identification of clinical findings that might further assist the clinician in making an early diagnosis of meningococcal infection could potentially improve outcomes from this disease.Muscle and joint pain, particularly associated with arthritis and gait disturbance, are sporadically but not uniformly mentioned in review articles and textbooks as features of meningococcal disease. 1,4,6 In the course of reviewing charts of children with invasive meningococcal disease in previous investigations, 5,7-9 we noted that extremity pain and refusal to walk were not uncommon clinical findings at the time of presentation.…”

“…[1][2][3][4][5][6] Some children with invasive meningococcal disease, however, present in a more subtle manner with fever without clinical toxicity and other nonspecific symptoms, such as cough, rhinorrhea, vomiting, and headache, resembling an upper respiratory tract infection or other viral illness. [5][6][7] Although early recognition and treatment of meningococcal disease decreases complications, 7 neither the physical examination nor the hematologic evaluation reliably enables health care providers to differentiate these children from those with other, less serious illnesses. 5 The identification of clinical findings that might further assist the clinician in making an early diagnosis of meningococcal infection could potentially improve outcomes from this disease.…”

“…[5][6][7] Although early recognition and treatment of meningococcal disease decreases complications, 7 neither the physical examination nor the hematologic evaluation reliably enables health care providers to differentiate these children from those with other, less serious illnesses. 5 The identification of clinical findings that might further assist the clinician in making an early diagnosis of meningococcal infection could potentially improve outcomes from this disease.…”