Immune complex reaction after successful treatment of meningococcal disease: an excellent response to IVIG

Abstract

The convalescence phase of severe meningococcal sepsis is complicated by immune complex reactions with arthritis being the commonest. No standard guidelines exist for management of such complications, but non-steroidal anti-inflammatory drugs and steroids have been used with varying success. We report excellent response to intravenous immunoglobulin in a child with immune complex reaction following meningococcal sepsis.

A Comprehensive Review of Meningococcal Disease Burden in India

“…These 32 publications reported data on meningococcal disease from different regions of India: Delhi ( n = 11) [ 16 , 24 – 26 , 34 , 40 , 45 – 47 , 52 , 53 ], Karnataka ( n = 5) [ 36 , 43 , 44 , 49 , 50 ], Assam ( n = 3) [ 28 , 32 , 33 ], Kashmir ( n = 2) [ 27 , 41 ], Chandigarh ( n = 2) [ 37 , 51 ], Meghalaya ( n = 2) [ 30 , 31 ], multiple states ( n = 2) [ 38 , 39 ], Maharashtra ( n = 1) [ 29 ], Uttar Pradesh ( n = 1) [ 23 ], Odisha ( n = 1) [ 48 ], Tripura ( n = 1) [ 42 ] and Tamil Nadu ( n = 1) [ 35 ] (Table 2 ).…”

“…The majority of publications reported data on endemic meningococcal disease ( n = 23) [ 23 – 25 , 27 – 29 , 31 – 33 , 35 – 38 , 40 , 43 , 44 , 46 , 48 – 53 ]. Of these 23 publications, 11 were case reports [ 23 – 25 , 31 , 33 , 37 , 44 , 46 , 48 , 52 , 53 ]. Lastly, 9 publications of the 32 reported data on meningococcal disease in epidemic settings [ 16 , 26 , 30 , 34 , 39 , 41 , 42 , 45 , 47 ] (Table 2 ).…”

“…Case reports covered the pediatric (n = 5) [23,25,46,48,52], adolescent (n = 3) [24,31,37], adult (n = 2) [44,53] and neonatal (n = 1) [33] populations with ages ranging between 14 days and 21 years (Table 2).…”

“…As shown in Table S2, clinical presentations included symptoms such as fever, headache, neck stiffness, purpuric rash and rarer symptoms perhaps reflecting complex immune reactions, such as joint pains, myocarditis, wheeze and crepitation in the left lower chest [31,37,44,48,53]. However, it is not uncommon that meningococci are isolated (culture) from such sites [54,55].…”

Invasive Meningococcal Infection: Analysis of 110 cases from a Tertiary Care Centre in North East India

“…Immune complex reactions are usually treated with non-steroidal anti-inflammatory drugs or steroids. Some may require intravenous immunoglobin [19].…”