A meta-analytic evaluation of sex differences in meningococcal disease incidence rates in 10 countries

Positive Predictive Value of Contrast-Enhanced Fluid-Attenuated Inversion Recovery (FLAIR) Magnetic Resonance Imaging in Diagnosis of Meningitis Among Pediatrics Taking Cerebrospinal Fluid Analysis as Gold Standard

BACKGROUND AND OBJECTIVE

Cerebrospinal fluid (CSF) analysis is the gold standard for meningitis diagnosis. It is invasive, time-consuming, and can inoculate infection. CSF analysis is not appropriate for many children without significant clinical suspicion, and delaying decision-making can have negative consequences. Therefore, medical research has long focused on speedy, non-invasive meningitis diagnosis. This study aimed to examine the positive predictive value (PPV) of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (CE-FLAIR MRI) in meningitis diagnosis.

MATERIALS AND METHODS

It was a cross-sectional study that was conducted in the Department of Radiology, The Children's Hospital in Lahore, from December 29, 2017, to June 28, 2018. The 198 patients were included of either gender with an age of 1 to 15 years and underwent CE-FLAIR MRI due to suspicion of meningitis. The gold standard for meningitis diagnosis was cerebrospinal fluid analysis, while CE-FLAIR MRI results were graded as true positives and false positives. The chi-square test was used. The p-value less than 0.05 was taken as statistically significant.

RESULTS

The mean age of the patients was 4.18±2.48 years. The majority, 116 (58.6%), of the patients were aged below 5 years. There were 125 (63.1%) male and 73 (36.9%) female patients with a male-to-female ratio of 1.7:1. The diagnosis of meningitis using CE-FLAIR MRI was made in 187 (94.4%) patients with a PPV of 94.4%, which was further confirmed on CSF analysis. The PPV of CE-FLAIR-MRI across various subgroups based on the patient's age and gender were statistically insignificant, which showed consistency across all included age and gender groups (p > 0.05).

CONCLUSION

The contrast-enhanced FLAIR magnetic resonance imaging was found to have a high positive predictive value of 94.4% in the diagnosis of meningitis, taking cerebrospinal fluid analysis as the gold standard. CE-FLAIR MRI's noninvasive and ionizing radiation-free characteristics advocate its preferred use in future clinical practice.

Rare fatal case of purpura fulminans due to pneumococcal sepsis in a child, associated with multiorgan failure

Introduction

Streptococcus pneumoniae is one of the associated bacteria that can cause the rare but high mortality hematological pathology known as purpura fulminans (PF) in both adults and children. Pediatric patients with PF can progress quickly to sepsis and multiorgan failure, especially immunocompromised individuals and young children. Due to the thrombotic blockage of blood arteries in PF, there is diffuse intravascular thrombosis and hemorrhagic infarction of the skin, which evolves from ecchymosis to skin necrosis, risk of limb sequelae, sepsis and fatality.

Case report

We present a case of a previously healthy 1-year and 9-months old female who was admitted to the Intensive Care Unit of the National Institute of Infectious Diseases "Prof. Dr. Matei Balş"- Bucharest, Romania. On physical examination, she was febrile, hypotensive, tachycardic, and had erythematous patches on her left upper limb and trunk. Initial blood work was significant for creatinine 4.45 mg/dL, aspartate aminotransferase 112 U/L, alanine aminotransferase 130 U/L and fibrinogen 596 mg/dL. Hematological workup showed a white blood cells count of 34 × 109/L, hemoglobin 9.7 g/dL, platelets 23000/L, D-dimers 89000 μg/L, and elevated PT and aPTT. Broad-spectrum antibiotics vancomycin and ceftriaxone were administrated. A lumbar puncture was performed for cerebrospinal fluid (CSF) analysis and culture grew Streptococcus pneumoniae serotype 1A. She required peritoneal dialysis due to acute kidney injury (AKI) and surgeries for affected skin areas. After multiple organ system failures, our patient evolved rapidly to irreversible tissue necrosis and death.

Conclusions

We aim to report a rare case of PF associated with pneumococcal meningoencephalitis in an immunocompetent child, to better appreciate the risk of fatal evolution when managing this disease in children.

Invasive Disease Due to Neisseria meningitidis: Surveillance and Trends in Israel Prior to and during the COVID-19 Pandemic

Invasive meningococcal disease (IMD) is a devastating disease with significant mortality and long-term morbidity. The COVID-19 pandemic and containment measures have affected the epidemiology of infectious pathogens. This study's aim was to assess IMD trends in Israel prior to and during the COVID-19 pandemic. The Neisseria meningitidis invasive infection is a notifiable disease in Israel. Laboratory analysis includes serogrouping and molecular characterization. The overall national IMD incidence rate (1998-2022) was 0.8/100,000 population. The IMD incidence rates declined during the pandemic years (0.3/100,000 in 2020-2022 vs. 0.9/100,000 in 1998-2019). The number of notified IMD cases declined by 65% in 2020-2022. The case fatality rate among laboratory-confirmed IMD cases was 9% (47/521, 2007-2022). Mortality risk markers included cases' age (older) and socio-economic status (lower). Overall, most Neisseria meningitidis isolates were of serogroup B (62.6%), and the most prevalent clonal complex (CC) was CC32 (24.2%). Serogroup B prevailed in cases aged 0-9 years (74.5%) and less in cases aged 10 years and above (39%). Neisseria meningitidis serogroups and CC distribution altered recently with a decline in serogroup B fraction, an increase in serogroup Y, and a decline in CC32. Ongoing IMD surveillance is necessary to assess trends in circulating strains and support decision-making on meningococcal vaccination programs.

Sex-Related Differences in the Immune Response to Meningococcal Vaccinations During Adolescence

Background

Immune responses to pediatric vaccinations have been reported to differ according to sex. Such sex-differential responses may become more pronounced during adolescence due to hormonal differences. We investigated whether the vaccine response following primary vaccination against meningococcal serogroup A (MenA), MenW and MenY and booster vaccination against MenC differed between girls and boys using data from two clinical studies.

Methods

Children aged 10, 12, and 15 years, who had been primed with MenC vaccination between 14 months and 6 years of age, received a booster MenC vaccination or MenACWY vaccination. Polysaccharide-specific IgG concentrations and functional antibody titers [determined with the serum bactericidal antibody (SBA) assay] were measured at baseline, 1 month, 1 year, and 3 years (only MenC group) after vaccination. We calculated geometric mean concentrations and titers (GMC and GMT) ratios for girls vs. boys adjusted for age group. Additionally, we compared the proportion protected individuals between girls and boys at all timepoints.

Results

This study included 342 girls and 327 boys from two clinical trials. While MenAWY antibody levels did not differ consistently 1 month after vaccination, all GMC- and GMT-ratios were in favor of girls 1 year after vaccination [range: 1.31 (1.02–1.70) for MenA IgG to 1.54 (1.10–2.16) for MenW IgG]. Overall, MenC antibody levels were slightly higher in girls at all postvaccination timepoints (GMC- and GMT-ratios: 1.16/1.17 at 1 month, 1.16/1.22 at 1 year and 1.12/1.15 3 years postvaccination). Higher MenC antibody levels were observed in 12- and 15-year-old girls compared to boys of the same age, whereas 10-year-old boys and girls had similar antibody levels. The percentage of participants protected (SBA titer ≥ 8) was very high (95–100%) at all timepoints, and did not differ significantly between boys and girls.

Conclusion

Antibody responses were higher in girls than in boys for all serogroups at most timepoints after primary MenAWY vaccination and booster MenC vaccination. The differences in average titers were however small and the percentage participants with protective titers was very high for both sexes.

Gender differences in tuberculosis incidence rates-A pooled analysis of data from seven high-income countries by age group and time period

Introduction

Gender differences in the incidence rates for tuberculosis are occasionally reported. However, the magnitude and consistency of the differences by age group, among different populations, and over extended periods of time are not clear.

Materials and methods

We obtained national data from seven countries from open-access internet sites or personal communications with official representatives. We computed the male-to-female incidence rate ratios (IRRs) by country and year for every age group and pooled these ratios using meta-analytic methods. Meta-regression analysis was performed to estimate the contribution of age, country, and calendar years to the variation in the IRRs.

Results

In the age groups of < 1, 1-4, 5-9, and 10-14, the pooled male-to-female IRRs (with 95% CI) were as follows: 1.21 (1.05, 1.40), 0.99 (0.95, 1.04), 1.01 (0.96, 1.06), and 0.83 (0.77, 0.89), respectively. In the age groups 15-44, 45-64, and 65+ years, incidence rates were significantly higher in men, with IRRs of 1.25 (1.16, 1.35), 1.79 (1.56, 2.06), and 1.81 (1.66, 1.96), respectively. Meta-regression analysis revealed that age significantly contributed to the variation in the IRRs.

Conclusions

There were gender differences in the incidence rates for tuberculosis, with higher rates in boys aged less than one, no significant differences in boys of ages 1-9, and higher rates in boys/men older than 15. The only excess in female gender was in the age group 10-14 years. The age-related gender differences in tuberculosis incidence rates observed over several countries indicate the importance of including sex as a biological variable when assessing the risk factors for tuberculosis.