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Maturana Martínez D, Aguilera-Alonso D, García Mancebo J, Navarro ML, Hernández Sampelayo T, Rincón López EM, Santiago-García B, Saavedra-Lozano J, Santos M, Cercenado E. Enfermedad meningocócica invasiva en niños y adultos en un hospital terciario: epidemiología reciente y factores pronósticos. An Pediatr (Barc) 2019; 91:296-306. [DOI: 10.1016/j.anpedi.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/25/2018] [Accepted: 12/15/2018] [Indexed: 11/25/2022] Open
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Maturana Martínez D, Aguilera-Alonso D, García Mancebo J, Navarro ML, Hernández Sampelayo T, Rincón López EM, Santiago-García B, Saavedra-Lozano J, Santos M, Cercenado E. Invasive meningococcal disease in children and adults in a tertiary level hospital. Recent epidemiology and prognostic factors. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Whole-Genome Sequencing of Emerging Invasive Neisseria meningitidis Serogroup W in Sweden. J Clin Microbiol 2018; 56:JCM.01409-17. [PMID: 29321195 PMCID: PMC5869829 DOI: 10.1128/jcm.01409-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/08/2018] [Indexed: 11/20/2022] Open
Abstract
Invasive disease caused by Neisseria meningitidis serogroup W (MenW) has historically had a low incidence in Sweden, with an average incidence of 0.03 case/100,000 population from 1995 to 2014. In recent years, a significant increase in the incidence of MenW has been noted in Sweden, to an average incidence of 0.15 case/100,000 population in 2015 to 2016. In 2017 (1 January to 30 June), 33% of invasive meningococcal disease cases (7/21 cases) were caused by MenW. In the present study, all invasive MenW isolates from Sweden collected in 1995 to June 2017 (n = 86) were subjected to whole-genome sequencing to determine the population structure and to compare isolates from Sweden with historical and international cases. The increase of MenW in Sweden was determined to be due to isolates belonging to the South American sublineage of MenW clonal complex 11, namely, the novel U.K. 2013 lineage. This lineage was introduced in Sweden in 2013 and has since been the dominant lineage of MenW.
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Abstract
Invasive meningococcal disease causes meningitis and septicemia worldwide with highest rates of disease occurring in children <2 years of age, and in particular young infants. Vaccination during pregnancy has been a successful strategy for prevention of other infections in young infants, most notably tetanus, pertussis and influenza. However, few studies of meningococcal vaccines in pregnancy have been undertaken, and none include the most commonly used current vaccines to prevent disease by capsular groups A, B, C, W and Y. The limited data suggest that the older polysaccharide vaccines are immunogenic, but the impact on prevention of infant disease has not been measured. Further studies of MenB protein vaccines and MenA protein-polysaccharide conjugate vaccines in particular are needed if vaccination in pregnancy is to be utilized as an approach to prevention of meningococcal disease in young infants.
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Affiliation(s)
- Bahaa Abu Raya
- a Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia , Vancouver , BC , Canada
| | - Manish Sadarangani
- a Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia , Vancouver , BC , Canada.,b Oxford Vaccine Group, Department of Paediatrics , University of Oxford, Children's Hospital , Oxford , UK
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5
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Can we control all-cause meningococcal disease in Europe? Clin Microbiol Infect 2016; 22 Suppl 5:S103-S112. [DOI: 10.1016/j.cmi.2016.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/04/2016] [Accepted: 03/13/2016] [Indexed: 11/18/2022]
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Riordan FAI, Jones L, Clark J. Validation of two algorithms for managing children with a non-blanching rash. Arch Dis Child 2016; 101:709-13. [PMID: 26984401 DOI: 10.1136/archdischild-2015-309451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/16/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Paediatricians are concerned that children who present with a non-blanching rash (NBR) may have meningococcal disease (MCD). Two algorithms have been devised to help identify which children with an NBR have MCD. AIM To evaluate the NBR algorithms' ability to identify children with MCD. METHODS The Newcastle-Birmingham-Liverpool (NBL) algorithm was applied retrospectively to three cohorts of children who had presented with NBRs. This algorithm was also piloted in four hospitals, and then used prospectively for 12 months in one hospital. The National Institute for Health and Care Excellence (NICE) algorithm was validated retrospectively using data from all cohorts. RESULTS The cohorts included 625 children, 145 (23%) of whom had confirmed or probable MCD. Paediatricians empirically treated 324 (52%) children with antibiotics. The NBL algorithm identified all children with MCD and suggested treatment for a further 86 children (sensitivity 100%, specificity 82%). One child with MCD did not receive immediate antibiotic treatment, despite this being suggested by the algorithm. The NICE algorithm suggested 382 children (61%) who should be treated with antibiotics. This included 141 of the 145 children with MCD (sensitivity 97%, specificity 50%). CONCLUSIONS These algorithms may help paediatricians identify children with MCD who present with NBRs. The NBL algorithm may be more specific than the NICE algorithm as it includes fewer features suggesting MCD. The only significant delay in treatment of MCD occurred when the algorithms were not followed.
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Affiliation(s)
- F Andrew I Riordan
- Department of Child Health, Birmingham Heartlands Hospital, Birmingham, Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | - Laura Jones
- School of Clinical Medical Sciences (Child Health), University of Newcastle, Royal Hospital for Sick Children, Edinburgh, UK
| | - Julia Clark
- Great North Children's Hospital, Newcastle, Lady Cilento Children's Hospital, Brisbane, UK
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Dinkar A, Singh J, Atam V, Sahani KK, Patel ML. Self Mutilating Behaviour in Severe Meningococcal Infection; An Interesting Association. J Clin Diagn Res 2016; 10:OD03-4. [PMID: 27437275 DOI: 10.7860/jcdr/2016/17719.7719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/31/2016] [Indexed: 11/24/2022]
Abstract
Neisseria meningitidis most commonly manifests as asymptomatic colonization in the nasopharynx of healthy adolescents and adults. It may rarely present as invasive disease which may be either bacterial meningitis or meningococcal septicaemia. Hereby we report a case presented with fever and rashes, irritability followed by self mutilating behaviour who was diagnosed as a case of invasive meningococcal infection. He responded well to treatment with intravenous ceftriaxone and self mutilating behaviour was subsided completely after treatment. Necrosed tissues of fingers were amputated. With best of our knowledge, no similar case of self-mutilation associated with meningococcal infection has been reported yet.
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Affiliation(s)
- Anju Dinkar
- Assistant Professor, Department of Microbiology, Institute of Medical Science , BHU, Varanasi, Uttar Pradesh, India
| | - Jitendra Singh
- Senior Resident, Department of Medicine, King George Medical University , Lucknow, Uttar Pradesh, India
| | - Virendra Atam
- Professor, Department of Medicine, King George Medical University , Lucknow, India, Uttar Pradesh, India
| | - Krishna Kumar Sahani
- Senior Resident, Department of Medicine, King George Medical University , Lucknow, Uttar Pradesh, India
| | - Munna Lal Patel
- Assistant Professor, Department of Medicine, King George Medical University , Lucknow, Uttar Pradesh, India
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8
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Li Y, Zhou L, Qiu J, Liu D, Shi Y. Anti-cytokine and anti-endotoxin therapies for meningococcal disease. Hippokratia 2015. [DOI: 10.1002/14651858.cd004420.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yuning Li
- First Hospital of Lanzhou University; Department of Paediatrics; No. 1, Donggang West Road Lanzhou City Gansu China 730000
| | - Li Zhou
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
| | - Jie Qiu
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
| | - Donghai Liu
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
| | - Yongsheng Shi
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
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Rivero Calle I, Rodriguez-Tenreiro Sánchez C, Martinón-Torres F. [Meningococcal vaccines. Global epidemiological situation and strategies for prevention by vaccination]. Enferm Infecc Microbiol Clin 2015; 33:257-67. [PMID: 25795150 DOI: 10.1016/j.eimc.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
N. meningitidis is a major cause of meningitis and septicemia and a major public health problem in many countries. The disease, that can be fulminant, has a high mortality and may cause serious sequelae, even in cases of apparently optimal medical treatment. Chemoprophylaxis may prevent secondary cases among those in close contact with the ill, but, since secondary cases represent only 1%-2% of all meningococcal disease, chemoprophylaxis has a small impact when fighting most of endemic and epidemic forms. Given that al least 5% -15% of children and young adults are carriers, the fight against meningococcal disease based on chemotherapeutic elimination of nasopharyngeal colonization is virtually impossible. Therefore, immunization is the only rational way to combat this disease.
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Affiliation(s)
- Irene Rivero Calle
- Pediatría Clínica, Infectológica y Traslacional. Departamento de Pediatría, Hospital Clínico Universitario de Santiago, Unidad de Investigación en Vacunas, GENVIP, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, La Coruña, España.
| | - Carmen Rodriguez-Tenreiro Sánchez
- Pediatría Clínica, Infectológica y Traslacional. Departamento de Pediatría, Hospital Clínico Universitario de Santiago, Unidad de Investigación en Vacunas, GENVIP, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, La Coruña, España
| | - Federico Martinón-Torres
- Pediatría Clínica, Infectológica y Traslacional. Departamento de Pediatría, Hospital Clínico Universitario de Santiago, Unidad de Investigación en Vacunas, GENVIP, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, La Coruña, España
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Sadarangani M, Scheifele DW, Halperin SA, Vaudry W, Le Saux N, Tsang R, Bettinger JA. Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study. Clin Infect Dis 2015; 60:e27-35. [PMID: 25605282 DOI: 10.1093/cid/civ028] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neisseria meningitidis causes 500 000 cases of septicemia and meningitis worldwide annually, with approximately 200 cases in Canada each year. Previous studies describe a case-fatality rate of 5%-15% and up to 20% of survivors suffering from long-term disability. METHODS This study was performed in Canada between 2002 and 2011; the study area included >50% of the country's population. We identified risk factors associated with death and the development of complications in children and adults admitted to hospital with confirmed invasive meningococcal disease (IMD). Clinical information was obtained from hospital records. Risk factors for death and complications were analyzed by univariate and multivariable analyses. RESULTS Of 868 individuals hospitalized with IMD, there were 73 deaths (8.4%) and 157 (18%) developed complications. The most common complications were hearing loss (5.4%), skin scarring (5.4%), amputation (3.4%), renal dysfunction (2.6%), and seizures (2.5%). Mortality was independently associated with shock (adjusted odds ratio [aOR], 23.30; P<.0001), age (aOR, 1.02 per 1-year increased age; P<.0001), symptom onset within 24 hours of admission (aOR, 1.80; P=.0471), and admission to the intensive care unit (aOR, 0.41; P=.0196). Development of complications was independently associated with seizures (aOR, 4.55; P<.0001), shock (aOR, 3.10; P<.0001), abnormal platelet count (aOR, 2.14; P=.0002), bruising (aOR, 3.17; P=.0059), abnormal white blood cell count (aOR, 0.52; P=.0100), and prior antibiotic exposure (aOR, 0.27; P=.0273). CONCLUSIONS Outcomes following IMD remain poor in this resource-rich setting in the 21st century. These data identify priorities for clinical management of adults and children with IMD, and provide prognostic information for affected patients and their families and cost-effectiveness analyses for meningococcal vaccine programs.
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Affiliation(s)
- Manish Sadarangani
- Vaccine Evaluation Center, Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital and the University of British Columbia, Vancouver, Canada Department of Paediatrics, University of Oxford, United Kingdom
| | - David W Scheifele
- Vaccine Evaluation Center, Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton
| | - Nicole Le Saux
- Division of Infectious Disease, Children's Hospital of Eastern Ontario, Ottawa
| | - Raymond Tsang
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital and the University of British Columbia, Vancouver, Canada
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Systems for Paediatric Sepsis: A Global Survey. W INDIAN MED J 2014; 63:703-10. [PMID: 25867557 DOI: 10.7727/wimj.2013.326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/21/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the resources available for early diagnosis and treatment of paediatric sepsis at hospitals in developing and developed countries. METHODS This was a voluntary online survey involving 101 hospitals from 41 countries solicited through the World Federation of Pediatric Intensive and Critical Care Societies contact list and website. The survey was designed to assess the spectrum of sepsis epidemiology, patterns of applied therapies, availability of resources and barriers to optimal sepsis treatment. RESULTS Ninety per cent of respondents represented a tertiary or general hospital with paediatric intensive care facilities, including 63% from developed countries. Adequate triage services were absent in more than 20% of centres. Insufficiently trained personnel and lack of a sepsis protocol was reported in 40% of all sites. While there were specific guidelines for sepsis management in 78% of centres (n = 100), protocols for assessing sepsis patients were not applied in nearly 70% of centres. Lack of parental recognition of sepsis and failure of referring centres to diagnose sepsis were identified as major barriers by more than 50% of respondents. CONCLUSIONS Even among centres with no significant resource constraints and advanced medical systems, significant deficits in sepsis care exist. Early recognition and management remain a key issue and may be addressed through improved triage, augmented support for referring centres and public awareness. Focussed research is necessary at the institutional level to identify and address specific barriers.
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Norheim G, Sadarangani M, Omar O, Yu LM, Mølbak K, Howitz M, Olcén P, Haglund M, van der Ende A, Pollard AJ. Association between population prevalence of smoking and incidence of meningococcal disease in Norway, Sweden, Denmark and the Netherlands between 1975 and 2009: a population-based time series analysis. BMJ Open 2014; 4:e003312. [PMID: 24513866 PMCID: PMC3927814 DOI: 10.1136/bmjopen-2013-003312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the relationship between the prevalence of smoking in the population and incidence of invasive meningococcal disease (IMD) among children under 5 years of age. DESIGN Retrospective, longitudinal, observational study. Poisson regression controlled for confounding factors. SETTING Norway, Sweden, Denmark and the Netherlands between 1975 and 2009. POPULATION Total population of approximately 35 million people in these four countries. DATA SOURCES Data were collected from the Ministries of Health, National Statistics Bureaus and other relevant national institutes. RESULTS In Norway, there was a significant positive relationship between the annual prevalence of daily smokers among individuals aged 25-49 years and the incidence of IMD in children under 5 years of age, unadjusted (RR=1.04-1.06, 95% CI 1.02 to 1.07, p<0.001) and after adjustment for time of year (quarter), incidence of influenza-like illness and household crowding (RR=1.05-1.07, 95% CI 1.03 to 1.09, p<0.001). Depending on age group, the risk of IMD increased by 5.2-6.9% per 1% increase in smoking prevalence among individuals aged 25-49 years in adjusted analyses. Using limited datasets from the three other countries, unadjusted analysis showed positive associations between IMD in children related to older smokers in Sweden and the Netherlands and negative associations related to younger smokers in Sweden. However, there were no demonstrable associations between incidence of IMD and prevalence of smoking, after adjustment for the same confounding variables. CONCLUSIONS The reduced incidence of IMD in Norway between 1975 and 2009 may partly be explained by the reduced prevalence of smoking during this period. High-quality surveillance data are required to confirm this in other countries. Strong efforts to reduce smoking in the whole population including targeted campaigns to reduce smoking among adults may have a role to play in the prevention of IMD in children.
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Affiliation(s)
- Gunnstein Norheim
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
- Norwegian Institute of Public Health, Oslo, Norway
| | - Manish Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Omar Omar
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Kåre Mølbak
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen S, Denmark
| | - Michael Howitz
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen S, Denmark
| | - Per Olcén
- University of Örebro, Örebro, Sweden
| | | | - Arie van der Ende
- Department of Medical Microbiology, The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Center, Amsterdam, The Netherlands
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
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Kriz P, Wieffer H, Holl K, Rosenlund M, Budhia S, Vyse A. Changing epidemiology of meningococcal disease in Europe from the mid-20th to the early 21st Century. Expert Rev Vaccines 2014; 10:1477-86. [DOI: 10.1586/erv.11.117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Khatami A, Pollard AJ. The epidemiology of meningococcal disease and the impact of vaccines. Expert Rev Vaccines 2014; 9:285-98. [DOI: 10.1586/erv.10.3] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vyse A, Anonychuk A, Jäkel A, Wieffer H, Nadel S. The burden and impact of severe and long-term sequelae of meningococcal disease. Expert Rev Anti Infect Ther 2014; 11:597-604. [PMID: 23750731 DOI: 10.1586/eri.13.42] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review describes current knowledge on the severity and long-term sequelae of meningococcal disease (MD) specifically. The literature databases Medline and Embase were used by combining search terms for MD and Neisseria meningitidis with terms for severity, mortality and sequelae. Case fatality for sufferers of MD remains high, typically 5-10%, despite the best medical care. Long-term sequelae in survivors may include physical, neurological, cognitive, behavioral and psychological consequences, such as hearing loss, amputations, skin scarring and neurodevelopmental deficits. A significantly lower quality of life is seen in survivors of MD compared with unaffected controls, with detrimental effects of childhood MD continuing into adulthood. MD carries a substantial risk of long-term sequelae and mortality. This should be recognized by physicians treating patients with this disease and lends support for the implementation of preventative measures such as vaccination.
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Broken barriers, biomarkers, and blocking antibodies-endothelial activation in sepsis*: no snowflake in an avalanche ever feels responsible. -Voltaire/François-Marie Arouet (1694-1778). Pediatr Crit Care Med 2013; 14:720-1. [PMID: 24162958 DOI: 10.1097/pcc.0b013e31829b1ea8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Silva PSL, Iglesias SBO, Nakakura CH, de Aguiar VE, de Carvalho WB. The product of platelet and neutrophil counts (PN product) at presentation as a predictor of outcome in children with meningococcal disease. ACTA ACUST UNITED AC 2013; 27:25-30. [PMID: 17469729 DOI: 10.1179/146532807x170475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite improvement in the treatment of Neisseria meningitidis infection, meningococcal diseases (MD) are still an important cause of morbidity and mortality around the world. This study assessed the performance of the product of platelet and neutrophil counts (PN product) at the time of presentation to hospital as a predictor of outcome in children with MD. METHODS Retrospective evaluation of children with clinical MD admitted to two paediatric intensive care units in Brazil. RESULTS Seventy-two children aged 2-156 months were studied. Overall mortality was 19.7%. The PN product, the Glasgow Meningococcal Septicaemia Prognostic Score and the Paediatric Risk of Mortality score discriminated between survivors and non-survivors. A PN < or = 113 had a sensitivity of 28.6% (95% CI 8.6-58.1), specificity of 96.6% (95% CI 88.1-99.5) and positive and negative predictive values of 66.7% and 84.8%. The area under the receiver operating characteristic curve was 0.85 (95% CI 0.74-0.92). CONCLUSION The PN product had a lower performance than reported in previous studies from a developed country. The PN product, however, is a good indicator of mortality in MD but needs to be validated for the population to which it is being applied.
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Affiliation(s)
- Paulo Sérgio Lucas Silva
- Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal de São Paulo, Brazil.
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Kalsi JS, Abdel-Karim A, Brooke AE. A Rare Case of Osteonecrosis in the Premaxilla Following Meningococcal-Induced Disseminated Intravascular Coagulation. J Oral Maxillofac Surg 2012; 70:2814-8. [DOI: 10.1016/j.joms.2011.12.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/16/2011] [Indexed: 11/16/2022]
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Meningococcal disease in children in Merseyside, England: a 31 year descriptive study. PLoS One 2011; 6:e25957. [PMID: 22016791 PMCID: PMC3189236 DOI: 10.1371/journal.pone.0025957] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022] Open
Abstract
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1–4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.
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Abstract
Phage display technology is an emerging drug discovery tool. Using that approach, short peptides that mimic part of a carbohydrate's conformation are selected by screening a peptide-displaying phage library with anti-carbohydrate antibodies. Chemically synthesized peptides with an identified sequence have been used as an alternative ligand to carbohydrate-binding proteins. These peptides represent research tools useful to assay the activities of glycosyltransferases and/or sulfotransferases or to inhibit the carbohydrate-dependent binding of proteins in vitro and in vivo. Peptides can also serve as immunogens to raise anti-carbohydrate antibodies in vivo in animals. Phage display has also been used in single-chain antibody technology by inserting an immunoglobulin's variable region sequence into the phage. A single-chain antibody library can then be screened with a carbohydrate antigen as the target, resulting in a recombinant anti-carbohydrate antibody with high affinity to the antigen. This review provides examples of successful applications of peptide-displaying phage technology to glycobiology. Such an approach should benefit translational research by supplying carbohydrate-mimetic peptides and carbohydrate-binding polypeptides.
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Affiliation(s)
- Michiko N Fukuda
- Cancer Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037, USA.
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Li Y, Zhou L, Qiu J, Liu D, Shi Y. Anti-cytokine and anti-endotoxin therapies for meningococcal disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd004420.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ehrlich TR, Von Rosenstiel IA, Grootenhuis MA, Gerrits AI, Bos AP. Long-term psychological distress in parents of child survivors of severe meningococcal disease. ACTA ACUST UNITED AC 2009; 8:220-4. [PMID: 16087557 DOI: 10.1080/13638490400022246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study psychological distress in parents of child survivors of Severe Meningococcal Disease (SMD) after discharge of their child from the Paediatric Intensive Care Unit (PICU). METHODS This study approached parents of child survivors of SMD treated on the PICU between 1993-2001. Five cross-sectional groups were created for mothers and fathers separately. The five groups differed from each other by the period after discharge they entered the project (ranging from 3 months to 7 years after discharge). For research purposes, mothers and fathers (n = 192) individually completed the Goldberg General Health Questionnaire-30 (GHQ), measuring their level of psychological distress. STATISTICS Mean group scores were examined and a one-way-analysis of variance (ANOVA) performed to study differences between groups for mothers and fathers separately. In addition, percentages of parents with GHQ scores above cut-off were calculated and it was determined whether it differed from norm data. RESULTS Data reveal that both mothers and fathers experience high mean levels of psychological distress after discharge, showing no significant differences in group means over time. High percentages of parents experience psychological distress after discharge, if compared with the normal population. CONCLUSIONS Parents of child survivors of SMD experience profound and prolonged psychological distress after discharge. Future interventions should focus on follow-up care for this population to help them re-adjust after this stressful event.
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Affiliation(s)
- Tirtsa R Ehrlich
- Pediatric Psychosocial Department, Emma Children's Hospital/Academic Medical Centre of the University of Amsterdam, Amsterdam, The Netherlands
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Trotter CL, Maiden MCJ. Meningococcal vaccines and herd immunity: lessons learned from serogroup C conjugate vaccination programs. Expert Rev Vaccines 2009; 8:851-61. [PMID: 19538112 PMCID: PMC3988355 DOI: 10.1586/erv.09.48] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Effective vaccines provide direct protection to immunized individuals, but may also provide benefits to unvaccinated individuals by reducing transmission and thereby lowering the risk of infection. Such herd immunity effects have been demonstrated following the introduction of meningococcal serogroup C conjugate (MCC) vaccines, with reductions in disease attack rates in unimmunized individuals and significantly lower serogroup C carriage attributable to the vaccine introduction. In the UK, targeting teenagers for immunization was crucial in maximizing indirect effects, as most meningococcal transmission occurs in this age group. Questions remain regarding the duration of herd protection and the most appropriate long-term immunization strategies. The magnitude of the herd effects following MCC vaccination was largely unanticipated, and has important consequences for the design and evaluation of new meningococcal vaccines.
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Affiliation(s)
- Caroline L Trotter
- Department of Social Medicine, University of Bristol, Canynge Hall, Bristol, UK.
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Abstract
PURPOSE OF REVIEW Paediatric sepsis continues to be a disease with unacceptably high morbidity and mortality, despite huge advances in paediatric intensive care organization and technology. This review examines the epidemiology, pathophysiology and advances in the treatment of paediatric sepsis. RECENT FINDINGS Many studies initially reporting encouraging or positive results on adult patients with sepsis have subsequently been disproved either in further studies on adults or in proof-of-principle studies on children. Publication of treatment guidelines for paediatric sepsis has led to better organization and implementation of care; however, this has yet to translate into demonstrable improvement in outcome. We will examine the major therapeutic advances of recent years and put them into the context of paediatric sepsis, examining why they often have not translated into survival benefit. SUMMARY This review aims to evaluate the recent therapeutic advances and potential for further developments in the management of paediatric sepsis in the ICU.
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Paize F, Playfor SD. Improvements in the outcome of children with meningococcal disease. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:172. [PMID: 18001494 PMCID: PMC2556760 DOI: 10.1186/cc6140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Recent years have seen a marked reduction in the mortality of children with meningococcal disease in paediatric intensive care units (PICU); the reasons for this improvement are multifactorial. The mortality rates for critically ill children overall have improved and reasons for this are probably increased centralisation of PICU services and that fewer critically ill children are now looked after on adult units. Specific treatment pathways for sepsis have improved with the publication of clinical guidelines for children and initiatives such as the Surviving Sepsis Campaign. There is a continuing need to focus on the care delivered to children before reaching PICU and to minimise the morbidity suffered by survivors of this disease.
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Knoester H, Bronner MB, Bos AP, Grootenhuis MA. Quality of life in children three and nine months after discharge from a paediatric intensive care unit: a prospective cohort study. Health Qual Life Outcomes 2008; 6:21. [PMID: 18331652 PMCID: PMC2292170 DOI: 10.1186/1477-7525-6-21] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 03/11/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Improved survival in children with critical illnesses has led to new disease patterns. As a consequence evaluation of the well being of survivors of Pediatric Intensive Care Units (PICU) has become important. Outcome assessment should therefore consist of evaluation of morbidity, functional health and Health Related Quality of Life (HRQoL). Awareness of HRQoL consequences and physical sequelae could lead to changes in support during the acute phase and thereafter. The aim of this study was to evaluate HRQoL in PICU survivors. METHODS Prospective follow-up study three and nine months after discharge from a 14-bed tertiary PICU. Eighty-one of 142 eligible, previously healthy children were included from December 2002 through October 2005. HRQoL was assessed with the TNO-AZL Preschool Children Quality of Life Questionnaire (TAPQOL-PF) for children aged 1 to 6 years of age, the TNO-AZL Children's Quality of Life Questionnaire Parent Form (TACQOL-PF) for children aged 6 to 12 years of age, and the TNO-AZL Children's Quality of Life Questionnaire Child Form (TACQOL-CF) for children aged 8 to 15 years of age. The studied patients were compared with age appropriate normative data using non-parametric tests and effect sizes. RESULTS Thirty-one and 27 children, and 55 and 50 parents completed questionnaires respectively three and nine months after discharge. In 1-6 year old children parents reported more lung problems (3 and 9 months), worse liveliness (9 months) and better appetite and problem behaviour (3 months); in 6-12 year old children parents reported worse motor functioning (3 months); and 12-15 year old adolescents reported worse motor functioning (3 months). Large effect sizes indicating clinical significant differences in HRQoL with healthy control subjects were found on more domains. CONCLUSION In this small group of PICU survivors differences in HRQoL with the normative population exist three and nine months after discharge. Calculated effect sizes were smaller nine months after discharge. These changes suggest that HRQoL improves over time. More research is necessary but we believe that HRQoL assessment should be incorporated in follow-up programs of PICU survivors.
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Affiliation(s)
- Hendrika Knoester
- Paediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Madelon B Bronner
- Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Albert P Bos
- Paediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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27
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Abstract
Application of the new edition of the meningococcal treatment algorithm may help in the early management of critically ill patients
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Nadel S, Kroll JS. Diagnosis and management of meningococcal disease: the need for centralized care. FEMS Microbiol Rev 2007; 31:71-83. [PMID: 17233636 DOI: 10.1111/j.1574-6976.2006.00059.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Meningococcal infection remains a significant health problem in children, with a significant mortality and morbidity. Prompt recognition and aggressive early treatment are the only effective measures against invasive disease. This requires immediate administration of antibiotic therapy, and the recognition and treatment of patients who may have complications of meningococcal infection such as shock, raised intracranial pressure (ICP) or both. Encouragingly, its mortality has fallen in recent years. This is the result of several factors such as the centralization of care of seriously ill children in paediatric intensive care units (PICUs), the establishment of specialized mobile intensive care teams, the development of protocols for the treatment of meningococcal infection, and the dissemination by national bodies and charities of guidance about early recognition and management. We will review the pathophysiology and management of the different presentations of meningococcal disease and examine the possible role of adjunctive therapies.
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Affiliation(s)
- Simon Nadel
- Department of Paediatrics, St Mary's Hospital, London, UK.
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Knoester H, Grootenhuis MA, Bos AP. Outcome of paediatric intensive care survivors. Eur J Pediatr 2007; 166:1119-28. [PMID: 17823815 PMCID: PMC2039787 DOI: 10.1007/s00431-007-0573-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 07/10/2007] [Indexed: 01/26/2023]
Abstract
The development of paediatric intensive care has contributed to the improved survival of critically ill children. Physical and psychological sequelae and consequences for quality of life (QoL) in survivors might be significant, as has been determined in adult intensive care unit (ICU) survivors. Awareness of sequelae due to the original illness and its treatment may result in changes in treatment and support during and after the acute phase. To determine the current knowledge on physical and psychological sequelae and the quality of life in survivors of paediatric intensive care, we undertook a computerised comprehensive search of online databases for studies reporting sequelae in survivors of paediatric intensive care. Studies reporting sequelae in paediatric survivors of cardiothoracic surgery and trauma were excluded, as were studies reporting only mortality. All other studies reporting aspects of physical and psychological sequelae were analysed. Twenty-seven studies consisting of 3,444 survivors met the selection criteria. Distinct physical and psychological sequelae in patients have been determined and seemed to interfere with quality of life. Psychological sequelae in parents seem to be common. Small numbers, methodological limitations and quantitative and qualitative heterogeneity hamper the interpretation of data. We conclude that paediatric intensive care survivors and their parents have physical and psychological sequelae affecting quality of life. Further well-designed prospective studies evaluating sequelae of the original illness and its treatment are warranted.
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Affiliation(s)
- Hendrika Knoester
- Paediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
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30
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Affiliation(s)
- C Anthony Hart
- Department of Medical Microbiology, University of Liverpool, Liverpool L69 3GA.
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31
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Abstract
INTRODUCTION Meningococcal septicemia remains one of the most common infectious causes of admission to a pediatric intensive care unit. Numerous treatment strategies aimed at the thromboembolic complications inducing purpura fulminans and limb/digital ischemia have been attempted, with variable results. The successful use of medicinal leeches for pneumococcal purpura fulminans has been described, and we present a similar case of meningococcal purpura fulminans. PATIENT AND INTERVENTION A 5-wk-old female infant with meningococcal meningitis and septicemia and progressive purpura fulminans of the left hand was treated with medicinal leeches. Medicinal leeches were applied to the left dorsal hand on a daily basis for 4 consecutive days. RESULT The swelling and limited functionality visibly improved after 48 hrs, and by 120 hrs, perfusion in the distal phalanges of the thumb and middle finger was evident. Reperfusion of the distal phalanges was not fully sustained, and at 6 wks the plastic surgery department debrided the distal phalanges of her left hand, excluding the thumb. She fully recovered from the meningococcal septicemic shock; the functionality of her left thumb was preserved, and she has limited functionality of her left hand. CONCLUSION The unique combination of salivary products in leech therapy has theoretical benefits and requires future study.
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Affiliation(s)
- Ricky Dippenaar
- Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Children's Hospital, Tygerberg, South Africa
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32
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Smith I, Caugant DA, Høiby EA, Wentzel-Larsen T, Halstensen A. High case-fatality rates of meningococcal disease in Western Norway caused by serogroup C strains belonging to both sequence type (ST)-32 and ST-11 complexes, 1985-2002. Epidemiol Infect 2006; 134:1195-202. [PMID: 16650328 PMCID: PMC2870511 DOI: 10.1017/s0950268806006248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2006] [Indexed: 11/05/2022] Open
Abstract
A total of 293 meningococcal disease (McD) patients from Western Norway hospitalized during 1985-2002 were examined for risk factors related to death. The case-fatality rate (CFR) increased from 4% during 1985-1993 to 17% during 1994-2002. We analysed the phenotypic and genotypic characteristics of the meningococcal patient isolates, with the aim of identifying whether highly virulent meningococcal strains contributed to the increased CFR. The Norwegian epidemic strain B:15:P1.7,16/ST-32 complex was overall the most common phenotype/genotype (n=75) and caused most deaths (n=9; CFR 12.0%). However, fatality was significantly associated with disease caused by serogroup C meningococcal strains; C:15:P1.7,16/ST-32 and C:2a/ST-11 complex strains, which had the highest CFRs of 21.1% and 18.2% respectively. Serogroup B strains of the ST-32 complex differing by serotype and/or serosubtype from the epidemic strain had a CFR of 5.1%, while the CFR of disease caused by other strains (all phenotypes and genotypes pooled) was 2.2%. The distribution of phenotypes/clonal complexes varied significantly between 1985-1993 and 1994-2002 (P<0.001); B:15/ST-32 complex strains decreased whereas both C:15:P1.7,16/ST-32 complex strains and strains with other phenotypes/clonal complexes increased. Our results indicate that C:15:P1.7,16/ST-32 and C:2a/ST-11 complex strains were highly virulent strains and contributed to the high CFR of McD in patients from Western Norway. To reduce fatality, rapid identification of such virulent strains is necessary. In addition, early and specific measures should include public information, vaccination of populations at risk of disease and carriage eradication, when clustering of patients occurs.
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Affiliation(s)
- I Smith
- Institute of Medicine, University of Bergen, Bergen, Norway.
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Smith I, Bjørnevik AT, Augland IMB, Berstad A, Wentzel-Larsen T, Halstensen A. Variations in case fatality and fatality risk factors of meningococcal disease in Western Norway, 1985-2002. Epidemiol Infect 2006; 134:103-10. [PMID: 16409656 PMCID: PMC2870352 DOI: 10.1017/s0950268805004553] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2005] [Indexed: 11/07/2022] Open
Abstract
In a retrospective epidemiological study, 293 meningococcal disease patients hospitalized during 1985-2002, were examined for fatality and risk factors related to death. The overall case fatality rate (CFR) was 8.2%, but increased from 4% during 1985-1993 to 17% during 1994-2002. The latter 9-year period was characterized by more serogroup C infections and more patients with thrombocytopenia on admission to hospital. All patients categorized as meningitis on admission survived. Of the 24 patients who died, 21 had meningococcal skin rash on admission, 23 had an onset to admission time of < or =24 h, and 16 had severe septicaemia with hypotension and/or ecchymoses without meningitis on admission. By multivariate analyses, a short onset to admission time, >50 petechiae, thrombocytopenia and severe septicaemia on admission were associated with fatality. More lives could be saved through earlier admission to hospital. This can be achieved through more information to the public about the early signs of meningococcal septicaemia, with the recommendation to look for skin rash in patients with acute fever during the first day and night.
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Affiliation(s)
- I Smith
- Institute of Medicine, University of Bergen, Bergen, Norway.
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Casado-Flores J, Blanco-Quirós A, Nieto M, Asensio J, Fernández C. Prognostic utility of the semi-quantitative procalcitonin test, neutrophil count and C-reactive protein in meningococcal infection in children. Eur J Pediatr 2006; 165:26-9. [PMID: 16249930 DOI: 10.1007/s00431-005-1761-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 07/12/2005] [Indexed: 11/28/2022]
Abstract
UNLABELLED The aim was to determine whether semi-quantitative procalcitonin (PCT-Q) measurements on admission can identify the severity of meningococcal infection in children. A total of 65 children (mean age 2.4 years) with meningococcal disease were included in a prospective study. All patients were treated with antibiotics, rehydration, inotropic drugs and mechanical ventilation if presenting with shock or respiratory failure. On admission, blood was drawn for routine laboratory analyses including absolute neutrophil count (NC), C-reactive protein (CRP) and PCT-Q (immunochromatographic test). A total of 33 patients presented with septic shock on admission of whom 18 developed multiple organ dysfunction syndrome (MODS) and 9 died. Forty-three patients showed a very high PCT-Q level (>or=10 ng/ml), 12 showed values between 2-9.9 ng/ml and the remaining 10 patients showed PCT-Q levels<2 ng/ml. All patients with a PCT-Q level<10 ng/ml survived, whereas all those who developed MODS or died had PCT-Q levels>or=10 ng/ml. Receiver operator curve analysis showed that PCT-Q and NC had a high predictive value for MODS and death. PCT-Q showed a sensitivity of 100%, a negative predictive value of 100% and a negative likelihood ratio of 0.0 for MODS and death. CONCLUSION semi-quantitative procalcitonin levels under 10 ng/ml predict good outcome of children with meningococcal infection. It is a highly sensitive method to identify patients with an increased risk of multiple organ dysfunction syndrome or death.
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Affiliation(s)
- Juan Casado-Flores
- Paediatric Intensive Care Unit, Hospital Infantil Niño Jesús, Universidad Autónoma de Madrid, Avenida de Menéndez Pelayo 65, 28009, Madrid, Spain.
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Abstract
PURPOSE OF REVIEW The underlying pathophysiology of sepsis has long been disputed. Systemic vasodilatation is important in the development of shock and, in septic critically ill adults who have been volume resuscitated, the systemic pressure is often low and the cardiac output high. In septic children however, and especially in those with meningococcal septic shock, poor cardiac output as a consequence of depressed myocardial function seems to be important, often being the cause of death in these patients. There is much evidence for disturbance of myocardial performance, yet despite the literature, there is still no consensus on how best to manage this complication of meningococcal disease. RECENT FINDINGS Many mediators have been proposed as the cause of the reduced myocardial performance, most recently interleukin-6 has emerged as a possible candidate involved in the pathophysiology of the myocardial dysfunction. Cardiac troponin I has been shown to be a marker of myocardial injury and may be used to monitor left ventricular function. Newer treatments emerging to manage the dysfunction include reports of success with phosphodiesterase inhibitors. SUMMARY Accepting that myocardial dysfunction may be an important cause of the shock state in overwhelming meningococcal disease, the approach to management may need to be tailored appropriately. Although presently there is no targeted treatment, it may be that therapy focused on inhibiting or antagonising interleukin-6 will be helpful in the future. Regardless of the importance of myocardial depression, fluid resuscitation remains a cornerstone in the management of severe meningococcal disease.
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Affiliation(s)
- N Makwana
- Johanne Holly Meningococcal Research Fellow Institute of Child Health, Royal Liverpool Children's Hospital, Liverpool, UK.
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Thorburn K, Taylor N, Lopez-Rodriguez L, Ashworth M, de la Cal MA, van Saene HKF. High mortality of invasive pneumococcal disease compared with meningococcal disease in critically ill children. Intensive Care Med 2005; 31:1550-7. [PMID: 16167128 DOI: 10.1007/s00134-005-2803-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 08/09/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To ascertain outcome, patterns of disease, incidence of concurrent infection, superinfection and penicillin resistance in children requiring intensive care for Streptococcus pneumoniae infection and compare it to a similar disease pattern, namely Neisseria meningitidis b infection. DESIGN AND SETTING Prospective cohort study in a regional paediatric intensive care unit (PICU). PATIENTS AND PARTICIPANTS Children with invasive pneumococcal and meningococcal disease requiring intensive care. MEASUREMENTS AND RESULTS The study included 22 children with invasive pneumococcal disease (IPD), median age 14 months (interquartile range 3-52), median Paediatric Index of Mortality (PIM) 0.051 (0.028-0.066), median length of PICU stay 8.5 days (4-13). Four patients died, three (13.5%) attributable to IPD. Incidence of concurrent infection 27%. There were no superinfections. All S. pneumoniae were sensitive to cefotaxime; one isolate (3.7%) was resistant to penicillin. There were 186 children with meningococcal disease (MD), with a higher PIM (median 0.068, 0.033-0.108), older age (29 months, 10.7-77.9) and shorter length of PICU stay (median 3 days, 2-6). Eight (4.3%) children died from MD. Incidence of concurrent and superinfection was 18% and 6%, respectively in children with MD. All N. meningitidis cases were sensitive to cefotaxime and penicillin. The standardized mortality ratio was considerably higher with IPD (2.0) than with MD (0.52). CONCLUSIONS In invasive pneumococcal disease preventative measures including early recognition, immediate antibiotic therapy and vaccination need to be taken in the community, similar to the control of meningococcal disease. Invasive pneumococcal disease should command the same respect as meningococcal disease.
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Affiliation(s)
- Kentigern Thorburn
- Department of Paediatric Intensive Care, Royal Liverpool Children's Hospital, Alder Hey Hospital, Liverpool, L12 2AP, UK
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Slack R, Hawkins KC, Gilhooley L, Addison GM, Lewis MA, Webb NJA. Long-term outcome of meningococcal sepsis-associated acute renal failure. Pediatr Crit Care Med 2005; 6:477-9. [PMID: 15982443 DOI: 10.1097/01.pcc.0000163285.74452.23] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SETTING Twenty-one of 209 children admitted to the intensive care unit with meningococcal septicemia developed oliguric acute renal failure necessitating renal replacement therapy. PATIENTS Twelve survivors underwent renal assessment at a median of 4.2 yrs postpresentation. RESULT Two had abnormal glomerular filtration rate, proteinuria, and hypertension; one had isolated proteinuria; and one had an isolated renal parenchymal defect on DMSA scan. CONCLUSION Long-term follow-up of this population is recommended.
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Affiliation(s)
- Rachael Slack
- Department of Intensive Care, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK
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Ninis N, Phillips C, Bailey L, Pollock JI, Nadel S, Britto J, Maconochie I, Winrow A, Coen PG, Booy R, Levin M. The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases. BMJ 2005; 330:1475. [PMID: 15976421 PMCID: PMC558454 DOI: 10.1136/bmj.330.7506.1475] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease. DESIGN Case-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases. SETTING National statistics and hospital records. SUBJECTS All children under 17 years who died from meningococcal disease (cases) matched by age with three survivors (controls) from the same region of the country. MAIN OUTCOME MEASURES Predefined criteria defined optimal management. A panel of paediatricians blinded to the outcome assessed case records using a standardised form and scored patients for suboptimal management. RESULTS We identified 143 cases and 355 controls. Departures from optimal (per protocol) management occurred more frequently in the fatal cases than in the survivors. Multivariate analysis identified three factors independently associated with an increased risk of death: failure to be looked after by a paediatrician, failure of sufficient supervision of junior staff, and failure of staff to administer adequate inotropes. Failure to recognise complications of the disease was a significant risk factor for death, although not independently of absence of paediatric care (P = 0.002). The odds ratio for death was 8.7 (95% confidence interval 2.3 to 33) with two failures, increasing with multiple failures. CONCLUSIONS Suboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease. Improved training of medical and nursing staff, adherence to published protocols, and increased supervision by consultants may improve the outcome for these children and also those with other life threatening illnesses.
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Affiliation(s)
- Nelly Ninis
- Infectious Diseases Unit, Department of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W2 1PG.
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Faibis S, Widmer R, Sapir S, Peretz B, Shapira J. Meningococcal septicaemia and dental complications: a literature review and two case reports. Int J Paediatr Dent 2005; 15:213-9. [PMID: 15854119 DOI: 10.1111/j.1365-263x.2005.00628.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present report describes two cases of dental complications of meningococcemia at an early age. The meningococcal infection in these young children resulted in limb amputation and significant plastic surgery. Dental treatment and psychological considerations are described in both cases. Similar dental complications, especially in the premaxilla, were found. Some of the severely affected teeth were extracted.
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Affiliation(s)
- S Faibis
- Department of Pediatric Dentistry, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
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40
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Shepard CW, Ortega-Sanchez IR, Scott RD, Rosenstein NE. Cost-effectiveness of conjugate meningococcal vaccination strategies in the United States. Pediatrics 2005; 115:1220-32. [PMID: 15867028 DOI: 10.1542/peds.2004-2514] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The US Food and Drug Administration approved a meningococcal conjugate A/C/Y/W-135 vaccine (MCV-4) for use in persons aged 11 to 55 years in January, 2005; licensure for use in younger age groups is expected in 2 to 4 years. OBJECTIVE To evaluate and compare the projected health and economic impact of MCV-4 vaccination of US adolescents, toddlers, and infants. DESIGN Cost-effectiveness analysis from a societal perspective based on data from Active Bacterial Core Surveillance (ABCs) and other published and unpublished sources. Sensitivity analyses in which key input measures were varied over plausible ranges were performed. SETTING AND PATIENTS A hypothetical 2003 US population cohort of children 11 years of age and a 2003 US birth cohort. INTERVENTIONS Hypothetical routine vaccination of adolescents (1 dose at 11 years of age), toddlers (1 dose at 1 year of age), and infants (3 doses at 2, 4, and 6 months of age). Each vaccination scenario was compared with a "no-vaccination" scenario. MAIN OUTCOME MEASURES Meningococcal cases and deaths prevented, cost per case prevented, cost per life-year saved, and cost per quality-adjusted life-year saved. RESULTS Routine MCV-4 vaccination of US adolescents (11 years of age) would prevent 270 meningococcal cases and 36 deaths in the vaccinated cohort over 22 years, a decrease of 46% in the expected burden of disease. Before program costs are counted, adolescent vaccination would reduce direct disease costs by $18 million and decrease productivity losses by $50 million. At a cost per vaccination (average public-private price per dose plus administration fees) of $82.50, adolescent vaccination would cost society $633000 per meningococcal case prevented and $121000 per life-year saved. Key variables influencing results were disease incidence, case-fatality ratio, and cost per vaccination. The cost-effectiveness of toddler vaccination is essentially equivalent to adolescent vaccination, whereas infant vaccination would be much less cost-effective. CONCLUSIONS Routine MCV-4 vaccination of US children would reduce the burden of disease in vaccinated cohorts but at a relatively high net societal cost. The projected cost-effectiveness of adolescent vaccination approaches that of recently adopted childhood vaccines under conditions of above-average meningococcal disease incidence or at a lower cost per vaccination.
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Affiliation(s)
- Colin W Shepard
- Division of Viral Hepatitis, National Center for Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, MS G37, Atlanta, GA 30333, USA.
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Tibby SM. Paediatric sepsis and multiple organ failure. Br J Hosp Med (Lond) 2005; 66:152-7. [PMID: 15791874 DOI: 10.12968/hmed.2005.66.3.17684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mortality from paediatric sepsis and multiple organ failure has fallen over the last half century, but both remain significant causes of death and morbidity among children and infants in the intensive care unit. This article provides a basic guide for front-line clinicians involved in paediatric resuscitation, addressing nomenclature, epidemiology and suggestions for early treatment.
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Affiliation(s)
- Shane M Tibby
- Department of Paediatric Intensive Care, Guy's Hospital, London SE1 9RT
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Festa MS, Tibby SM, Taylor D, Durward A, Habibi P, Murdoch IA. Early application of generic mortality risk scores in presumed meningococcal disease. Pediatr Crit Care Med 2005; 6:9-13. [PMID: 15636652 DOI: 10.1097/01.pcc.0000149132.51906.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mortality from meningococcal disease typically occurs within 24 hrs of intensive care unit (ICU) admission. An early, accurate mortality-risk tool may aid in trial design for novel therapies. We assessed the performance of two generic scores that assign mortality risk within 1 hr of ICU admission: the Preintensive Care Pediatric Risk of Mortality (Pre-ICU PRISM) and Pediatric Index of Mortality (PIM). DESIGN Prospective, observational study over 21 months. SETTING Two tertiary pediatric ICUs accepting referrals from southeast England. PATIENTS Patients were 165 consecutive children with meningococcal disease. Ages ranged from 0.1 to 17 yrs (median 2.3 yrs). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS PIM demonstrated greater sensibility, with complete data collected in 93% of cases, compared with 35% for the pre-ICU PRISM. Both scores discriminated well. The area under the receiver operating characteristic curve was 0.90 (95% confidence interval, 0.81-1.00) for PIM and 0.94 (95% confidence interval, 0.88-0.98) for Pre-ICU PRISM; this did not change when applied to the subgroup of patients with complete data. Both scores calibrated poorly, overestimating mortality in the medium-risk strata (and also in the high-risk stratum in the case of Pre-ICU PRISM). When used as a stratification tool for a hypothetical trial (60% reduction in mortality, 80% power), the scores allowed for a reduction in study size by 50% (PIM) and 43% (pre-ICU PRISM). CONCLUSIONS Pre-ICU PRISM and PIM both discriminate well but calibrate poorly when applied to a cohort of children with meningococcal sepsis. Both scores provide an effective means of stratification for clinical trial purposes. The main advantage for PIM appears to be ease of data collection.
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Heyderman RS, Ben-Shlomo Y, Brennan CA, Somerset M. The incidence and mortality for meningococcal disease associated with area deprivation: an ecological study of hospital episode statistics. Arch Dis Child 2004; 89:1064-8. [PMID: 15499066 PMCID: PMC1719724 DOI: 10.1136/adc.2003.036004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine whether incidence, mortality, and case fatality for meningococcal disease (MD) differs by area deprivation, and if this has changed over time. METHODS The population of children aged less than 5 years with MD was analysed as quintiles of area deprivation scores over two time periods, 1995-99 and 1991-94. Annual age standardised rates were calculated and the association between incidence, mortality, and area deprivation quintiles assessed using Poisson regression and the risk ratios determined. Case fatality was calculated from the odds ratio of mortality by area deprivation score for the two time periods. RESULTS There were 10,524 cases of MD and 441 deaths (4.2%). Incidence rates were higher for 1995-99 (45.4 per 100,000) compared to 1991-94 (27.4 per 100,000). Mortality rates remained stable over time, indicating a decline in risk of death of around 40%. The incidence rates for the most deprived quintile were around twice those for the most affluent quintile, but this gradient declined over time. A threefold gradient was seen for mortality rates across the top and bottom quintiles, which was constant over time. The odds of mortality did not show a linear pattern, with mortality being lowest in the first and highest in the second and fifth area deprivation quintiles. CONCLUSIONS These data show that MD incidence and mortality are socially patterned. The determinants of case fatality are more complex and require further investigation.
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Affiliation(s)
- R S Heyderman
- Department of Pathology & Microbiology, School of Medical Sciences, University of Bristol, University Walk, UK.
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Baines P, Carrol ED. Recombinant tissue plasminogen activator in children with meningococcal purpura fulminans—Role uncertain*. Crit Care Med 2004; 32:1806-7. [PMID: 15286574 DOI: 10.1097/01.ccm.0000133331.07204.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blanco Quirós A, Casado Flores J, Nieto Moro M, Garrote Adrados JA, Arranz Sanz E, Asensio Antón J. Sepsis meningocócica en pediatría. Parámetros asociados a mala evolución. An Pediatr (Barc) 2004; 61:305-13. [PMID: 15456585 DOI: 10.1016/s1695-4033(04)78393-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mortality due to meningococcal sepsis continues to be extremely high. Patients with a poor prognosis require aggressive therapy and should be identified early. OBJECTIVE To investigate the clinical and biological factors associated with poor outcome. PATIENTS AND METHOD Seventy-one children aged 2 months to 13 years with meningococcal sepsis were studied. Inclusion criteria were meningococcus isolation in cultures or characteristic clinical features with purpuric exanthema. METHODS A correlational descriptive study was performed. In all patients we evaluated the Pediatric Risk of Mortality (PRISM), the Glasgow Scale for Meningococcal Sepsis (GSMS), polymorphonuclear (PMN) count and prolactin (PRL), leptin (LPT) and C-reactive protein (CRP) levels. RESULTS Fourteen children (19.7 %) died. Death was associated with multiple organ dysfunction syndrome (MODS) (p = 0.0001), high GSMS and PRISM scores (p = 0.0001) and to a lesser extent with shock (p = 0.01). In patients who died, the determinations showing greatest alteration at admission were PRL levels (p = 0.0009) and PMN count (p = 0.0005). CRP levels were not associated with differences in mortality but were high in patients with shock (p = 0.008). Children with high body weight percentiles were at greater risk of death and showed higher levels of PRL, PCT (p = 0.006) and LPT (p = 0.006), without differences in GSMS or PRISM scores. Age did not influence mortality or PRL levels but did influence GMSM and PRISM scores and PMN and CRP levels. These differences disappeared after the age of 2-3 years. In patients with MODS or shock, the only differences found were reduced PMN count (p = 0.0001) and elevated PRL levels (p = 0.0001). CONCLUSIONS In meningococcal sepsis, death is more frequent in children with high body weight percentiles. Moreover, these children present elevated PRL and LPT levels, although whether these variables act independently remains to be elucidated.
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Affiliation(s)
- A Blanco Quirós
- Area de Pediatría e Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid, Spain.
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Abstract
Aggressive early treatment of meningococcal disease can reduce mortality. This relies on prompt recognition and treatment of the complications of septicaemia and meningitis, appropriate ongoing intensive care where necessary, and adequate management of multiple organ failure. Most children with meningococcal disease survive intact, but long term sequelae are increasingly recognised and make follow up essential. New treatments continue to be evaluated, but none has so far proven to be effective in further reducing morbidity or mortality. Simple, timely therapeutic manoeuvres may greatly improve the prospects for survival.
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Affiliation(s)
- S B Welch
- Department of Paediatrics, Faculty of Medicine, Imperial College London, St Mary's Hospital, London, UK
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Abstract
This review describes the mechanisms of the immune response to meningococcal disease, examining the extent to which individual variation of the immune response can determine susceptibility. It concludes by summarising the difficulties encountered by recent efforts to develop new immunomodulatory treatments.
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Berkley JA, Ross A, Mwangi I, Osier FHA, Mohammed M, Shebbe M, Lowe BS, Marsh K, Newton CRJC. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 2003; 326:361. [PMID: 12586667 PMCID: PMC148891 DOI: 10.1136/bmj.326.7385.361] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify clinical indicators of immediate, early, and late mortality in children at admission to a sub-Saharan district hospital and to develop prognostic scores. DESIGN Prospective cohort study. SETTING One district hospital in Kenya. PARTICIPANTS Children aged over 90 days admitted to hospital from 1 July 1998 to 30 June 2001. MAIN OUTCOME MEASURES Prognostic indicators of mortality. RESULTS Of 8091 children admitted up to 1 June 2000, 436 (5%) died. Sixty (14%) died within four hours after admission (immediate), 193 (44%) after 4-48 hours (early), and 183 (42%) after 48 hours (late). There were marked differences in the clinical features associated with immediate, early, and late death. Seven indicators (neurological status, respiratory distress (subcostal indrawing or deep breathing), nutritional status (wasting or kwashiorkor), severe anaemia, jaundice, axillary temperature, and length of history) were included in simplified prognostic scores. Data from 4802 children admitted from 1 July 2000 to 30 June 2001 were used to validate the scores. For simplified prognostic scores the areas under the receiver operating characteristic curves were 0.93 (95% confidence interval 0.92 to 0.94), 0.82 (0.80 to 0.83), and 0.82 (0.81 to 0.84) for immediate, early, and late death, respectively. CONCLUSION In children admitted to a sub-Saharan hospital, the prognostic indicators of early and late deaths differ but a small number of simple clinical signs predict outcome well.
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Affiliation(s)
- J A Berkley
- KEMRI Centre for Geographic Medicine Research (Coast), PO Box 230, Kilifi, Kenya.
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Heyderman RS, Lambert HP, O'Sullivan I, Stuart JM, Taylor BL, Wall RA. Early management of suspected bacterial meningitis and meningococcal septicaemia in adults. J Infect 2003; 46:75-7. [PMID: 12634067 DOI: 10.1053/jinf.2002.1110] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R S Heyderman
- Department of Pathalogy and Microbiology, School of Medical Sciences, University of Bristol, UK.
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