Predictors of outcome in acute meningococcal infection in children

Algren, John T.; Lal, Suresh; Cutliff, Sue; Richman, Barbara J.

doi:10.1097/00003246-199303000-00024

Cited by 64 publications

(16 citation statements)

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“…No se encontró asociación de mayor mortalidad con algún grupo etario, a diferencia de lo hallado por Kaplan y cols (17) por ejemplo, quienes constataron mayor mortalidad en el grupo etario de ≥11 años. Un 29,5% de nuestros pacientes recibieron antibioticoterapia previa, similar a otras series, sin asociación a mortalidad (25,26).…”

Section: Junio 2018unclassified

Epidemiology, clinical and prognostic factors of Invasive Meningococcal Disease in a reference center in Paraguay. 2005 to 2018

Amarilla

Lovera

Cuéllar

et al. 2018

Rev. Inst. Med. Trop

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ResumenIntroducción: La enfermedad meningocóccica ha sido y sigue siendo una causa importante de morbilidad y mortalidad. Objetivos: Analizar las características clínicas y epidemiológicas de pacientes con infección meningocóccica invasora hospitalizados en un centro hospitalario de referencia. Materiales y métodos: Estudio descriptivo, observacional y retrospectivo de revisión de historias clínicas de pacientes internados entre los años 2005 y 2018 en el Instituto de Medicina Tropical con aislamiento o detección de N. meningitidis en sangre o LCR. Resultados: Fueron captados 44 pacientes con enfermedad meningocóccica invasora durante el periodo estudiado (3±2 casos/año). Los casos predominaron en el grupo etario <5 años (36% de todos os casos), siendo la distribución de sexo similar. Veintiseis pacientes (59%) presentaron meningitis y 18 (41%) meningococcemia, 12 de ellos (27%) con meningitis concomitante. El 43% de los pacientes requirió ingreso a UCI. La letalidad fue del 20,5% (9/44), superior en pacientes con meningococcemia, aunque sin significancia estadística (p=0,16). La presencia de choque (p<0,01), el requerimiento deUCI (p=0,001), la leucopenia <5000, leucocitos/mm 3 (p<0,01), la leucocitosis >15000 /mm 3 (p=0,03), la plaquetopenia<150000/mm 3 (p=0,01) y la presencia de <100 leucocitos/campo en LCR (p=0,02) fueron factores asociados a mayor mortalidad. No se Junio 2018Rev.Inst.Med.Trop2018;13(1)41-54 10.18004/imt/20181341-54 encontró asociación entre severidad con serotipos. Al analizar en conjunto todos los años, el serogrupo B fue el predominante (50%); sin embargo, en los últimos 3 años todos los aislamientos (n=14) correspondieron a los serogrupos C (n=10, 71%) y W135 (n=4, 29%). Conclusión: La enfermedad meningocóccica presenta en el Paraguay un patrón estable de endemicidad, con un aumento reciente de casos de serogrupo C y W135, representado el serogrupo C más del 70% de los casos actuales. La presencia de choque, la leucocitosis >15000 /mm 3 , la leucopenia <5000/ mm 3 , y la plaquetopenia se asociaron a mayor mortalidad. AbstractIntroduction: Meningococcal disease has been and continues to be an important cause of morbidity and mortality around the world. Objectives: To analyze the clinical and epidemiological characteristics of patients with invasive meningococcal infection hospitalized in a reference hospital center. Materials and methods: A descriptive, observational and retrospective study based in the review of clinical records of patients admitted between 2005 and 2018 in the Institute of Tropical Medicine in whom Neisseria meningitidis was isolated o detected by PCR in blood or CSF. Results: Forty-four patients with invasive meningococcal disease were recruited during the period studied (3 ± 2 cases/year). The cases predominated in the age group <5 years (36% of all cases), with similar gender distribution. Forty-six patients (59%) had meningitis and 18 (41%) meningococcemia, 12 of them (27%) with concomitant meningitis. Forty-three percent of the patients required admission to the ICU...

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Section: Junio 2018unclassified

Epidemiology, clinical and prognostic factors of Invasive Meningococcal Disease in a reference center in Paraguay. 2005 to 2018

Amarilla

Lovera

Cuéllar

et al. 2018

Rev. Inst. Med. Trop

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“…3.4. Algren et al [14] This was a retrospective study followed by a prospective validation study of a score developed from the retrospective data. This review focused only on the retrospective study, as it presented the findings of individual predictors.…”

Section: Fakhir Ahmad and Ahmadmentioning

confidence: 99%

Prediction in meningococcal disease: A literature review

Sabra

Benger

2015

J Pediatr Infect Dis

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Meningococcal disease is a global burden with an estimated annual death rate of 170000 worldwide. The disease has an overall mortality greater than 10%. Despite these figures, several studies demonstrate that the management of children with severe meningococcal sepsis and septic shock is suboptimal. Most children received inadequate fluid resuscitation and inotropic support during their admission. Hence, this paper presents a review of relevant literature of prediction studies and discusses clinical and methodological issues, which may have influenced the results. It concludes that several studies have investigated the predictors of a poor clinical outcome in this condition, but there is a lack of studies that consider prediction of fluid and inotrope requirements as an outcome measure. The identification of such predictors would allow treatment to be directed to those children most likely to benefit, with a long term goal of improving patient outcome.

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“…Purpura fulminans develops in 15% to 25% of those with meningococcemia (6)(7)(8)(9). It can develop during infection with any of the meningococcal serogroups; endotoxin production, however, appears to be highest among serogroup C isolates (10).…”

Section: Epidemiologymentioning

confidence: 99%

“…Although several factors have been identified as predictive of a poor outcome from meningococcemia, size of skin hemorrhage increases with disease severity (12), and the presence of purpura, particularly when generalized, is associated with high morbidity and mortality, as it reflects a profound disturbance in hemostatic mechanisms (8,(13)(14)(15)(16)(17)(18)(19)(20)(21). While the overall fatality rate in children with meningococcemia in the United States is less than 15%, development of PF heralds mortality in 20% to 60% of cases.…”

Section: Epidemiologymentioning

confidence: 99%

“…Of those who survive, the majority have cutaneous and skeletal deformities due to gangrene (22,23). The presence of petechiae signals septicemia, and onset within 12 hours of initial medical evaluation has been associated with poor outcome in some studies (24,25) but not in others (6,8,17). Thus PF, distinct from petechiae or other cutaneous manifestations of meningococcemia such as a maculopapular eruption, is an important marker of a poor outcome.…”

Section: Epidemiologymentioning

confidence: 99%

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Acute Infectious Purpura Fulminans: Pathogenesis and Medical Management

Darmstadt

1998

Pediatric Dermatology

145

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Purpura fulminans (PF) is a potentially disabling and life-threatening disorder characterized by acute onset of progressive cutaneous hemorrhage and necrosis, and disseminated intravascular necrosis. Acute infectious PF occurs most commonly in the setting of meningococcemia due to elaboration of endotoxin. Presence of purpura, particularly when generalized, is an important predictor of a poor outcome following meningococcal infection. Histopathologic hallmarks of acute infectious PF are dermal vascular thrombosis and secondary hemorrhagic necrosis, findings which are identical to those of the Shwartzman reaction. Acute infectious PF and the Shwartzman reaction have a common pathogenesis, involving a disturbance in the balance of anticoagulant and procoagulant activities of endothelial cells. This disturbance, which is triggered by endotoxin, appears to be mediated by cytokines, particularly interleukin-12, interferon-gamma, tumor necrosis factor-alpha, and interleukin-1, leading to the consumption of proteins C and S and antithrombin III. State-of-the-art therapeutic interventions based on recent advances in our understanding of the pathogenesis of acute infectious PF are discussed.

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Predictors of outcome in acute meningococcal infection in children

Cited by 64 publications

References 0 publications

Epidemiology, clinical and prognostic factors of Invasive Meningococcal Disease in a reference center in Paraguay. 2005 to 2018

Epidemiology, clinical and prognostic factors of Invasive Meningococcal Disease in a reference center in Paraguay. 2005 to 2018

Prediction in meningococcal disease: A literature review

Acute Infectious Purpura Fulminans: Pathogenesis and Medical Management

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