1
|
Pallua N, Heimann K, Almarzouqi F, Bohr S. Early-onset compartment syndrome of the limbs, a rare complication of meningococcal septicemia in infants? JPRAS Open 2015. [DOI: 10.1016/j.jpra.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
2
|
Analgesia-sedation in PICU and neurological outcome: a secondary analysis of long-term neuropsychological follow-up in meningococcal septic shock survivors*. Pediatr Crit Care Med 2014; 15:189-96. [PMID: 24366510 DOI: 10.1097/pcc.0000000000000044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To investigate whether analgesic and sedative drug use during PICU treatment is associated with long-term neurodevelopmental outcome in children who survived meningococcal septic shock. DESIGN This study concerned a secondary analysis of data from medical and psychological follow-up of a cross-sectional cohort of all consecutive surviving patients with septic shock and purpura requiring intensive care treatment between 1988 and 2001 at the Erasmus MC-Sophia Children's Hospital. At least 4 years after PICU admission, these children showed impairments on several domains of neuropsychological functioning. In the present study, type, number, and dose of sedatives and analgesics were retrospectively evaluated. SETTING Tertiary care university hospital. PATIENTS Seventy-seven meningococcal septic shock survivors (median age, 2.1 yr). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Forty-five patients (58%) received one or more analgesic and/or sedative drugs during PICU admission, most commonly benzodiazepines (n = 39; 51%), followed by opioids (n = 23; 30%). In total, 12 different kinds of analgesic or sedative drugs were given. The use and dose of opioids were significantly associated with poor test outcome on full-scale intelligence quotient (p = 0.02; Z = -2.28), verbal intelligence quotient (p = 0.02; Z = -2.32), verbal intelligence quotient subtests (verbal comprehension [p = 0.01; Z = -2.56] and vocabulary [p = 0.01; Z = -2.45]), and visual attention/executive functioning (Trial Making Test part B) (p = 0.03; Z = -2.17). In multivariate analysis adjusting for patient and disease characteristics, the use of opioids remained significant on most neuropsychological tests. CONCLUSIONS The use of opioids during PICU admission was significantly associated with long-term adverse neuropsychological outcome independent of severity of illness scores in meningococcal septic shock survivors.
Collapse
|
3
|
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.
Collapse
Affiliation(s)
- Paulo Sérgio Lucas Silva
- Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal de São Paulo, Brazil.
| | | | | | | | | |
Collapse
|
4
|
Coutinho LG, Grandgirard D, Leib SL, Agnez-Lima LF. Cerebrospinal-fluid cytokine and chemokine profile in patients with pneumococcal and meningococcal meningitis. BMC Infect Dis 2013; 13:326. [PMID: 23865742 PMCID: PMC3717124 DOI: 10.1186/1471-2334-13-326] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 07/09/2013] [Indexed: 01/27/2023] Open
Abstract
Background Bacterial meningitis is characterized by an intense inflammatory reaction contributing to neuronal damage. The aim of this study was to obtain a comparative analysis of cytokines and chemokines in patients with pneumococcal (PM) and meningococcal meningitis (MM) considering that a clear difference between the immune response induced by these pathogens remains unclear. Methods The cyto/chemokines, IL-1β, IL-2, IL-6, TNF-α, IFN-γ, IL-10, IL-1Ra, CXCL8/IL-8, CCL2/MCP-1, CLL3/MIP-1α, CCL4/MIP-1γ and G-CSF, were measured in cerebrospinal fluid (CSF) samples from patients with PM and MM. Additionally, a literature review about the expression of cytokines in CSF samples of patients with MB was made. Results Concerning cytokines levels, only IFN-γ was significantly higher in patients with Streptococcus pneumoniae compared to those with Neisseria meningitidis, regardless of the time when the lumbar puncture (LP) was made. Furthermore, when samples were compared considering the timing of the LP, higher levels of TNF-α (P <0.05) were observed in MM patients whose LP was made within 48 h from the initial symptoms of disease. We also observed that the index of release of cyto/chemokines per cell was significantly higher in PM. From the literature review, it was observed that TNF-α, IL-1β and IL-6 are the best studied cytokines, while reports describing the concentration of the cytokine IL-2, IL-1Ra, G-CSF and CCL4/MIP-1β in CSF samples of patients with bacterial meningitis were not found. Conclusion The data obtained in this study and the previously published data show a similar profile of cytokine expression during PM and MM. Nevertheless, the high levels of IFN-γ and the ability to release high levels of cytokines with a low number of cells are important factors to be considered in the pathogenesis of PM and thereby should be further investigated. Moreover, differences in the early response induced by the pathogens were observed. However, the differences observed are not sufficient to trigger changes in the current therapy of corticosteroids adopted in both the PM and MM.
Collapse
|
5
|
Controversies in neurology, Vienna, 2012: Steroids in bacterial meningitis: no. J Neural Transm (Vienna) 2012; 120:343-6. [DOI: 10.1007/s00702-012-0939-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
|
6
|
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]
|
7
|
Sunita, Singh M, Kapoor D. Atypical meningococcal meningitis with rashless presentation: A case report. JOURNAL OF ACUTE DISEASE 2012. [DOI: 10.1016/s2221-6189(13)60017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
8
|
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.
Collapse
Affiliation(s)
- Tirtsa R Ehrlich
- Pediatric Psychosocial Department, Emma Children's Hospital/Academic Medical Centre of the University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
9
|
Woolley SL, Smith DRK, Surridge J. Knee pain: an unusual late complication of meningococcal septicaemia. Eur J Emerg Med 2008; 15:97-9. [DOI: 10.1097/mej.0b013e32826fb783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Uberos J, Molina-Carballo A, Galdo-Muñoz G, Muñoz-Hoyos A. Total antioxidant capacity of plasma in asymptomatic carrier state of Neisseria meningitidis. Epidemiol Infect 2007; 135:857-60. [PMID: 17109775 PMCID: PMC2870636 DOI: 10.1017/s0950268806007539] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2006] [Indexed: 12/13/2022] Open
Abstract
Reduction of the antioxidant capacity of plasma has been linked with the impairment of an effective immune response and so we hypothesized that the carriage rate of Neisseria meningitidis in asymptomatic subjects might correlate with the levels of antioxidants in plasma. To this end we took pharyngeal swabs from 339 children in Marquesado Basic Health Zone, Granada, Spain and in addition determined the total antioxidant capacity (TAC) in plasma samples from these subjects. The overall prevalence of N. meningitidis carriage was 5.9% (mean age 7.1 years) with rates of 10.3% in children aged 3 < or =years, 3.9% between 4 and 7 years and 2.4% in older subjects. Plasma TAC for the < or =3-year-olds was 0.13 for carriers and 1.10 for non-carrier controls (P=0.04), 0.13 for carriers aged 4-7 years (controls 0.63) and 0.28 for carriers aged >7 years (controls 0.52). We analysed the association between TAC in plasma (<0.37 - 2 S.D.) and the carrier state of N. meningitidis. In the carrier state, the odds ratio for this association (TAC in plasma <0.25) was 8.44 (95% CI 1.5-48.9). These findings may suggest a reduced immune response in the host favourable to nasopharyngeal persistence of meningococci.
Collapse
Affiliation(s)
- J Uberos
- Departamento de Pediatría, Hospital Clínico San Cecilio, Granada, Spain.
| | | | | | | |
Collapse
|
11
|
Ranjit S, Kissoon N, Gandhi D, Dayal A, Rajeshwari N, Kamath SR. Early differentiation between dengue and septic shock by comparison of admission hemodynamic, clinical, and laboratory variables: a pilot study. Pediatr Emerg Care 2007; 23:368-75. [PMID: 17572519 DOI: 10.1097/01.pec.0000278403.22450.a2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the clinical, hemodynamic, and laboratory variables, treatment, and outcome in dengue shock syndrome (DSS) and septic shock (SS), with an aim to permit early differentiation at presentation to the emergency department. DESIGN Retrospective chart review. SETTING A tertiary care pediatric emergency and critical care unit. PATIENTS Thirty-two patients (16 DSS and 16 SS) between June 2004 and December 2005 who were treated in the emergency department and intensive care using protocols. INTERVENTIONS None. RESULTS There were no differences between groups in terms of age, number with decompensated shock, and Pediatric Risk of Mortality III scores. Differences between DSS and SS were found in heart rate, 120 +/- 39 beats per minute versus 158 +/- 35 beats per minute (P < 0.01); pulse pressures, 25 +/- 8 mm Hg versus 43 +/- 8 mm Hg (P < 0.01); presence of systemic inflammatory response syndrome, 9/16 versus 15/16 (P < 0.05); Glasgow Coma Score, 13 +/- 3 versus 10 +/- 4 (P < 0.05); hematocrit, 42 +/- 6 versus 29 +/- 7 (P < 0.01); and median platelet count, 29,000/mm3 (interquartile range, 20,500-57,500/mm3) versus 115,500/mm3 (interquartile range, 91,750-182,250/mm3 in SS) (P < 0.01). Patients with SS were more likely to require greater than 40 mL/kg of fluid for initial resuscitation, ventilation, and vasoactive support for shock compared with those with dengue. In the fluid and catecholamine refractory patients, 6 of 16 SS versus 0 of 16 DSS patients were treated with steroids (P < 0.05). The outcome was similar in both groups, with 2 of 16 deaths among children with SS and 1 of 16 in those with DSS. CONCLUSIONS Dengue shock syndrome is likely a distinct entity from SS with some overlapping features. The DSS patients are significantly less likely to have systemic inflammatory response syndrome, be tachycardic, and have a narrower pulse pressure at admission when compared with SS patients. Mental status is better preserved, and spontaneous clinical bleeding is more common in children with DSS compared with those in SS. These likely results from the predominantly vasodilatory state in SS versus vasoconstrictory state that is the initial response in DSS.
Collapse
Affiliation(s)
- Suchitra Ranjit
- Pediatric Intensive Care Unit, Apollo Hospitals, Chennai, India
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
The differential diagnosis of a fever and rash presenting in a pediatric patient is quite extensive. This article is not all-inclusive but is meant to aid in the diagnosis to differentiate serious, life-threatening eruptions from more benign common rashes.
Collapse
Affiliation(s)
- Cheryl Aber
- Miller School of Medicine, University of Miami, Department of Dermatology and Cutaneous Surgery, Cedar Medical Center, Miami, Florida 33125, USA.
| | | | | |
Collapse
|
13
|
Manchanda V, Bhalla P. Emergence of non-ceftriaxone-susceptible Neisseria meningitidis in India. J Clin Microbiol 2006; 44:4290-1. [PMID: 17005740 PMCID: PMC1698303 DOI: 10.1128/jcm.01903-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
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.
Collapse
Affiliation(s)
- N Makwana
- Johanne Holly Meningococcal Research Fellow Institute of Child Health, Royal Liverpool Children's Hospital, Liverpool, UK.
| | | |
Collapse
|
15
|
Abstract
OBJECTIVE In 2004, a consensus meeting of critical care and infectious disease experts was organized to review and make recommendations on current definitions of infections, sepsis, and organ failure for neonates and children and for the predisposing conditions leading to these diseases. Among the infections leading to sepsis, meningococcemia is so distinguishable that a separate article on its diagnosis and management was thought to be warranted. DESIGN AND METHODS The process included a modified Delphi method, a consensus conference, subsequent smaller meetings of subgroups and key individuals, and electronic-based discussion among subgroups. A systematic review of the literature was undertaken. CONCLUSIONS Early recognition and treatment of likely meningococcal sepsis has led to decreased mortality. Since the start of vaccination against serogroup C, the prevalence of this disease has decreased. Not only the possible presence of a meningococcal sepsis is important, but also the assessment of the shock state and the severity of disease and the possible presence of meningoencephalitis. There are also a number of genetic predispositions determining the severity of disease. The only three randomized trials in this disease have led to the conclusion that mortality is not a stable end point. Improvement in organ function, morbidity (including amputations), and functional outcome are better outcome measures.
Collapse
Affiliation(s)
- Jan A Hazelzet
- Pediatric Intensive Care, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Monteiro MA, Fortuna-Nevin M, Farley J, Pavliak V. Phase-variation of the truncated lipo-oligosaccharide of Neisseria meningitidis NMB phosphoglucomutase isogenic mutant NMB-R6. Carbohydr Res 2003; 338:2905-12. [PMID: 14667712 DOI: 10.1016/j.carres.2003.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The detection of antibodies specific to meningococcal lipo-oligosaccharides (LOSs; outer-core-->inner-core-->lipid A) in sera of patients convalescent from meningococcal infection suggests the potential use of LOS as a vaccine to combat pathogenic Neisseria spp. Removal of the outer-core region, which expresses glycans homologous to human blood-group antigens, is a required first-step in order to avoid undesirable immunological reactions following vaccination. To this end, we describe here the structural makeup of the LOS produced by serogroup B N. meningitidis NMB isogenic phosphoglucomutase (Pgm) mutant (NMB-R6). The dominant LOS types produced by NMB-R6 expressed a deep-truncated inner-core region, GlcNAc-(1-->2)-LDHepII-(1-->3)-LDHepI-(1-->5)-[Kdo-2-->4]-Kdo-->lipid A, with one PEA unit attached at either O-6 or O-7 of LDHepII, or with two simultaneously PEA moieties attached at O-3 and O-6 or O-3 and O-7 of the same unit. Unexpectedly, this mutation did not completely deactivate the production of Glc, as some LOS molecules were observed to carry Glc at O-4 of LDHepI and at O-3 of LDHepII. A glycoconjugate vaccine comprised of NMB-R6 LOSs is currently being evaluated in our laboratory.
Collapse
MESH Headings
- Acetylglucosamine/analysis
- Carbohydrate Sequence
- Chromatography, Gas
- Electrophoresis, Polyacrylamide Gel
- Ethanolamines/analysis
- Galactose/analysis
- Glucose/analysis
- Glucosephosphates/metabolism
- Heptoses/analysis
- Lipopolysaccharides/chemistry
- Lipopolysaccharides/isolation & purification
- Magnetic Resonance Spectroscopy
- Molecular Sequence Data
- Mutation/genetics
- Neisseria meningitidis, Serogroup B/chemistry
- Neisseria meningitidis, Serogroup B/enzymology
- Neisseria meningitidis, Serogroup B/genetics
- Oligosaccharides, Branched-Chain/chemistry
- Phosphoglucomutase/genetics
- Phosphoglucomutase/metabolism
- Spectrometry, Mass, Electrospray Ionization
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
- Sugar Acids/analysis
Collapse
Affiliation(s)
- Mario A Monteiro
- Wyeth Vaccines Research, 211 Bailey Road, West Henrietta, NY 14586, USA.
| | | | | | | |
Collapse
|