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Abraham P, Marin G, Filleron A, Michon AL, Marchandin H, Godreuil S, Rodière M, Sarrabay G, Touitou I, Meslin P, Tournier C, Van de Perre P, Nagot N, Jeziorski E. Evaluation of post-infectious inflammatory reactions in a retrospective study of 3 common invasive bacterial infections in pediatrics. Medicine (Baltimore) 2022; 101:e30506. [PMID: 36197203 PMCID: PMC9509192 DOI: 10.1097/md.0000000000030506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Infectious diseases can result in unanticipated post-infectious inflammatory reactions (PIIR). Our aim was to explore PIIR in 3 frequent pediatric bacterial invasive infections in France by a retrospective monocentric study. We included children hospitalized between 2003 and 2012 for Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), or Streptococcus pyogenes invasive infections. The PIIR had to have occurred between 3 and 15 days without fever despite an individually tailored antibiotic therapy. A descriptive analysis was carried out to determine PIIR risk factors. We included 189 patients, of whom 72, 79, and 38 exhibited invasive infections caused by S pyogenes, SP, and NM, respectively. The mean age was 44 months. PIIR were observed in 39 cases, occurring after a median of 8 days (5-12), with a median duration of 3 days (2-6). Fever, arthritis, and pleural effusion were observed in 87%, 28.2%, and 25.6%, respectively. In multivariate analysis, PIIR were associated with pleuropneumonia, hospitalization in an intensive care unit (ICU), and elevated C-reactive protein (CRP). PIIR were observed in 20% of children after SP, NM, or S pyogenes invasives infections. Their occurrence was associated with the initial severity but not the etiological microorganism. Further studies are warranted to confirm these findings.
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Affiliation(s)
| | - Gregory Marin
- Departement d’Information Medicale, CHU Montpellier, Montpellier, France
| | - Anne Filleron
- Department de pédiatrie, CHU Nîmes, Université de Montpellier, Nîmes, France
- IRMB, Université de Montpellier, INSERM, Montpellier, France
| | | | - Hélène Marchandin
- HydroSciences Montpellier, University of Montpellier, CNRS, IRD, Montpellier, France
- Laboratoire de microbiologie, CHU Nîmes, Nîmes, France
| | - Sylvain Godreuil
- Laboratoire de bactériologie, CHU Montpellier, Montpellier, France
- UMR MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Michel Rodière
- Département urgences, post-urgences, CHU Montpellier, Montpellier, France
| | | | | | - Pauline Meslin
- Service de pédiatrie générale, CH Perpignan, Perpignan, France
| | - Carine Tournier
- Département urgences, post-urgences, CHU Montpellier, Montpellier, France
| | | | - Nicolas Nagot
- Departement d’Information Medicale, CHU Montpellier, Montpellier, France
- PCCEI, Univ Montpellier, Université de Antilles, Inserm, EFS, Montpellier, France
| | - Eric Jeziorski
- Département urgences, post-urgences, CHU Montpellier, Montpellier, France
- CeRéMAIA, CHU Montpellier, Montpellier, France
- PCCEI, Univ Montpellier, Université de Antilles, Inserm, EFS, Montpellier, France
- *Correspondence: Eric Jeziorski, Centre Hospitalier Universitaire Montpellier, Hôpital Arnaud de Villeneuve, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France (e-mail: )
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Sudbury EL, O'Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis 2021; 26:1355-1363. [PMID: 32568047 PMCID: PMC7323526 DOI: 10.3201/eid2607.181941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Neisseria meningitidis serogroup W has emerged as an increasingly common cause of invasive meningococcal disease worldwide; the average case-fatality rate is 10%. In 2017, an unprecedented outbreak of serogroup W infection occurred among the Indigenous pediatric population of Central Australia; there were 24 cases over a 5-month period. Among these cases were atypical manifestations, including meningococcal pneumonia, septic arthritis, and conjunctivitis. The outbreak juxtaposed a well-resourced healthcare system against unique challenges related to covering vast distances, a socially disadvantaged population, and a disease process that was rapid and unpredictable. A coordinated clinical and public health response included investigation of and empiric treatment for 649 febrile children, provision of prophylactic antimicrobial drugs for 465 close contacts, and implementation of a quadrivalent meningococcal ACWY conjugate vaccine immunization program. The response contained the outbreak within 6 months; no deaths and only 1 case of major illness were recorded.
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Affiliation(s)
- Rebecca C Brady
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 6014, Cincinnati, OH 45229-3039, USA.
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4
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Sudbury EL, O’Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis 2020. [DOI: 10.3201/eid2607.181491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Fulminant Neisseria meningitidis septicaemia with purpura fulminans requiring limb amputation. IDCases 2019; 19:e00673. [PMID: 31879595 PMCID: PMC6920294 DOI: 10.1016/j.idcr.2019.e00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/17/2019] [Accepted: 11/17/2019] [Indexed: 12/05/2022] Open
Abstract
Despite the isolation of Neisseria meningitidis over 200 years ago, meningococcal disease remains a feared cause of bacterial sepsis, with significant morbidity and mortality, despite prompt antibiotic use and modern critical care support. Neisseria meningitides is a Gram-negative encapsulated diplococcus, which exists only in the human host (Kvalsvig and Unsworth, 2003). The bacterium can cause life-threatening septic shock and coagulopathy, which may rapidly manifest within a matter of hours from preceding mild symptoms (Kvalsvig and Unsworth, 2003). Whilst N. meningitidis is recognised as a common commensal organism in the nasopharynx, associated with asymptomatic carriage in up to 10 %, manifestation of life-threatening disease is rare (Rappuoli and Pizza, 2015). We report the case of 31-year-old male presenting with devastating meningococcal septicaemia with disseminated intravascular coagulopathy (DIC) and purpura fulminans, requiring surgical debridement and a right above-knee amputation for sepsis-driven skin necrosis. The patient suffered extensive tissue loss secondary to a type 3 immune hypersensitivity reaction involving immune-complex mediated inflammation and tissue necrosis. Due to a strong immune component driving the patient’s failure to convalesce pulsed intravenous methylprednisolone was used alongside antimicrobial therapy. The use of steroids was associated with fever subsidence and significant clinical improvement, highlighting the benefit of corticosteroid use in immune-complex mediated pathology.
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Martellosio JP, Lauda-Maillen M, Landron C, Le Moal G, Allouchery M, Arrivé F, Roblot P, Martin M. [Inflammatory myopathy following acute meningoccemia in a properdin-deficient patient: A case report]. Rev Med Interne 2019; 41:46-49. [PMID: 31735371 DOI: 10.1016/j.revmed.2019.10.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Myalgia is a classical sign in invasive meningococcal diseases (IMD), but severe and persistent myalgia following an IMD have never been reported to date. CASE REPORT A 20-year-old man presented with purpura fulminans and meningitis caused by Neisseria meningitidis serogroup Y, revealing properdin deficiency. Although meningitis symptoms improved after antibiotherapy, initial myalgia of the lower limbs increased, associated with mild rhabdomyolysis. Magnetic resonance imaging (MRI) revealed an increased STIR (Short TI inversion recovery) signal of both quadriceps muscles, without abscess. After exclusion of other causes of myopathy, a post-infectious myositis was diagnosed. A four-week course of corticosteroids led to dramatic improvement. CONCLUSION Post-infectious inflammatory myopathy should be suspected in case of severe and persistent myalgia associated with rhabdomyolysis following an IMD, after exclusion of pyomyositis especially. A short course of corticosteroids seems to be effective.
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Affiliation(s)
- J-P Martellosio
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France.
| | - M Lauda-Maillen
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France
| | - C Landron
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France
| | - G Le Moal
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France
| | - M Allouchery
- Service de pharmacologie clinique et vigilances, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - F Arrivé
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France
| | - P Roblot
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France
| | - M Martin
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, 2 rue de la Milétrie, 86021 Poitiers cedex, France
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Parody N, Cacheiro-Llaguno C, Osuna C, Renshaw-Calderón A, Alonso C, Carnés J. Circulating immune complexes levels correlate with the progression of canine leishmaniosis in naturally infected dogs. Vet Parasitol 2019; 274:108921. [PMID: 31536867 DOI: 10.1016/j.vetpar.2019.108921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/03/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022]
Abstract
Dogs are the main domestic reservoir of Leishmania infantum, and in cases of uncontrolled infection, a strong humoral immune response is elicited, which is inefficient against the parasites. Previous studies have suggested that an adequate antigen/antibody ratio, with a moderate prevalence of antigens with respect to the antibodies, could result in the formation of circulating immune complexes (CIC) in canine leishmaniosis (CanL). Deposition of these complexes in tissues has been associated with vasculitis, uveitis, arthritis, dermatitis and especially glomerulonephritis and renal failure. However, little is known about the relationship between the presence of CIC and disease progression. The aim of this study was to evaluate serum CIC level and its correlation with disease severity in infected dogs with different stages of disease and non-infected animals as a control. A total of 60 dogs were included in the study, classified according to the proposed LeishVet classification criteria: healthy non-infected (n = 13); healthy infected (n = 12); sick stage I (n = 9); sick stage II (n = 17); sick stage III (n = 8); and sick stage IV (n = 1). CIC were isolated from serum samples using a modified polyethylene glycol precipitation method, and their levels measured by ELISA and bicinchoninic acid protein assay. A nanoparticle tracking analysis was performed to investigate the relationship between the molecular size distribution of the CIC and disease progression. In conclusion, the results confirmed a positive association between CIC levels, their molecular size and disease progression that suggests a potential use of CIC as biomarkers of CanL.
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Affiliation(s)
- Nuria Parody
- R&D Department, Laboratorios LETI S.L., Tres Cantos, Madrid, Spain
| | | | - Cristina Osuna
- R&D Department, Laboratorios LETI S.L., Tres Cantos, Madrid, Spain
| | - Ana Renshaw-Calderón
- Centro de Biología Molecular Severo Ochoa, CSIC-Universidad Autónoma de Madrid, Cantoblanco, Madrid, Spain
| | - Carlos Alonso
- Centro de Biología Molecular Severo Ochoa, CSIC-Universidad Autónoma de Madrid, Cantoblanco, Madrid, Spain
| | - Jerónimo Carnés
- R&D Department, Laboratorios LETI S.L., Tres Cantos, Madrid, Spain.
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Keeley AJ, Hammersley D, Dhamrait SS. A case of myopericarditis caused by Neisseria meningitidis W135 serogroup with protracted inflammatory syndrome. Clin Med (Lond) 2018; 18:253-255. [PMID: 29858438 PMCID: PMC6334081 DOI: 10.7861/clinmedicine.18-3-253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Meningococcal pericarditis is classically divided into three separate entities: isolated meningococcal pericarditis, disseminated meningococcal disease with pericarditis, and reactive (immunopathic) meningococcal pericarditis. We present the case of a 74-year-old woman with meningococcal septicaemia with meningococcal myopericarditis, which demonstrates crossover features.
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Chronopoulos A, Hoogewoud F, Steffen H, Thumann G. Parainfektiöse Optikusneuritis mit makulärem Infiltrat bei Neisseria-meningitidis-B-Meningitis. Ophthalmologe 2017; 114:945-949. [DOI: 10.1007/s00347-016-0404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Masson-Behar V, Jacquier H, Richette P, Ziza JM, Zeller V, Rioux C, Coustet B, Dieudé P, Ottaviani S. Arthritis secondary to meningococcal disease: A case series of 7 patients. Medicine (Baltimore) 2017; 96:e7573. [PMID: 28723791 PMCID: PMC5521931 DOI: 10.1097/md.0000000000007573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Arthritis secondary to invasive meningococcemia is rare and has been described as a direct result of bacteremia or as immunoallergic-type arthritis, related to the immune complex. Only a few case series have been reported.This multicenter study aimed to describe the clinical characteristics and therapeutic outcomes of arthritis secondary to meningococcal infection.We performed a 5-year retrospective study. We included all patients with inflammatory joint symptoms and proven meningococcal disease defined by the identification of Neisseria meningitidis in blood, cerebrospinal fluid, or synovial fluid. Septic arthritis was defined by the identification of N meningitidis in joint fluid. Immune-mediated arthritis was considered to be arthritis occurring after at least 1 day of invasive meningococcal disease without positive joint fluid culture.A total of 7 patients (5 males) with joint symptoms and meningococcal disease were identified. The clinical presentation was mainly oligoarticular and the knee was the most frequent joint site. Five patients had septic arthritis and 4 had immune-mediated arthritis; 2 had septic arthritis followed by immune-mediated arthritis. Immune-mediated arthritis occurred 3 to 7 days after meningococcal meningitis, and treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) led to improvement without complications.Physicians must be vigilant to the different clinical presentations in patients with arthritis associated with invasive meningococcal disease. If immune-mediated arthritis is suspected, NSAIDs are usually efficient.
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Affiliation(s)
- Vanina Masson-Behar
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| | - Hervé Jacquier
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Bactériologie-Virologie, Hôpital Lariboisière
| | - Pascal Richette
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Lariboisière
| | - Jean-Marc Ziza
- Service de Rhumatologie et Médecine Interne. Centre de Référence des Infections Ostéo-articulaire complexes. Groupe hospitalier Diaconesses Croix St-Simon
| | - Valérie Zeller
- Service de Rhumatologie et Médecine Interne. Centre de Référence des Infections Ostéo-articulaire complexes. Groupe hospitalier Diaconesses Croix St-Simon
| | - Christophe Rioux
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Maladie infectieuses, Hôpital Bichat, Paris, France
| | - Baptiste Coustet
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| | - Philippe Dieudé
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| | - Sébastien Ottaviani
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
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Abstract
Septic arthritis is a rheumatologic emergency that may lead to disability or death. Prompt evacuation of the joint, either by arthrocentesis at the bedside, open or arthroscopic drainage in the operating room, or imaging-guided drainage in the radiology suite, is mandatory. Methicillin-resistant Staphylococcus aureus (MRSA) has become a major cause of septic arthritis in the United States. MRSA joint infection seems to be associated with worse outcomes. Antibiotic courses of 3 to 4 weeks in duration are usually adequate for uncomplicated bacterial arthritis. Treatment duration should be extended to 6 weeks if there is imaging evidence of accompanying osteomyelitis.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-B420, Boston, MA 02115, USA.
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12
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Neisseria meningitidis presenting as acute abdomen and recurrent reactive pericarditis. Braz J Infect Dis 2016; 20:641-644. [PMID: 27631124 PMCID: PMC9427643 DOI: 10.1016/j.bjid.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022] Open
Abstract
Meningococcal meningitis is a well established potential fatal infection characterized by fever, headache, petechial rash, and vomiting in the majority of cases. However, protean manifestations including abdominal pain, sore throat, diarrhea and cough, even though rare, should not be overlooked. Similarly, although disseminated infection could potentially involve various organ-targets, secondary immune related complications including joints or pericardium should be dealt with caution, since they remain unresponsive to appropriate antibiotic regimens. We hereby report the rare case of an otherwise healthy adult female, presenting with acute abdominal pain masking Neisseria meningitidis serotype B meningitis, later complicated with recurrent reactive pericarditis despite appropriate antibiotic treatment. There follows a review of current literature.
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Abstract
Meningococcal disease is a life-threatening infection that may progress rapidly, even after appropriate treatment has commenced. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of infection. The outcome of meningococcal disease is critically dependent on prompt recognition of two important complications: shock and raised intracranial pressure. Rapid recognition of disease and of these complications, together with appropriate management is crucial to the outcome of affected patients. This article summarizes the clinical features of invasive meningococcal disease, diagnostic tools, treatment modalities, and common post-infection sequelae.
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Affiliation(s)
- Simon Nadel
- Paediatric Intensive Care Unit, St. Mary's Hospital and Imperial College London, London, United Kingdom.
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14
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Invasive meningococcal disease with pericarditis and pneumonia: A rare presentation in childhood. IDCases 2016; 4:41-2. [PMID: 27077027 PMCID: PMC4816901 DOI: 10.1016/j.idcr.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 11/23/2022] Open
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Suzuki N, Tagashira Y, Heist BS, Tsuda N, Watanuki S, Tani S, Honda H. Not Just Another Flare: Acute Polyarthritis in Rheumatoid Arthritis. Am J Med 2015; 128:e1-3. [PMID: 26299321 DOI: 10.1016/j.amjmed.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Noriko Suzuki
- Division of Infectious Diseases, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan
| | - Yasuaki Tagashira
- Division of Infectious Diseases, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan; Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan
| | - Brian S Heist
- Department of Medicine, University of Pittsburgh School of Medicine, Pa
| | - Naonori Tsuda
- Division of Infectious Diseases, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan; Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan
| | - Satoshi Watanuki
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan
| | - Shoichiro Tani
- Department of Orthopedic Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan; Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan.
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Saliou V, Bailly P, Thomas E, Carvajal-Alegria G, Ben Salem D, Timsit S. Syndrome de la queue de cheval après une méningite à Neisseria meningitidis de type C. Presse Med 2015; 44:567-9. [DOI: 10.1016/j.lpm.2014.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/27/2022] Open
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17
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Peters R, Virani F, Haddadin Y, Baldowska H. A pain in the joints. CASE REPORTS 2015; 2015:bcr-2014-207607. [DOI: 10.1136/bcr-2014-207607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Garriga-Grimau L, Laveglia V. Gammaglobulin treatment in an unusual meningococcal case. Indian J Pediatr 2014; 81:628. [PMID: 24057970 DOI: 10.1007/s12098-013-1226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Garriga-Grimau
- Department of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma Barcelona, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain,
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Filleron A, Marchandin H, Rodière M, Jeziorski E. Complications in the subacute phase of invasive Streptococcus pyogenes infections in pediatrics: two case reports and review of the literature. Clin Pediatr (Phila) 2014; 53:191-3. [PMID: 23460650 DOI: 10.1177/0009922813479164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Anne Filleron
- 1Centre Hospitalier Régional Universitaire de Montpellier, Hôpital Lapeyronie, Montpellier, France
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Pace D, Pollard AJ. Meningococcal disease: clinical presentation and sequelae. Vaccine 2012; 30 Suppl 2:B3-9. [PMID: 22607896 DOI: 10.1016/j.vaccine.2011.12.062] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/10/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
The clinical spectrum of invasive meningococcal disease is diverse with meningitis and/or septicaemia being the commonest modes of presentation. The severity of manifestations of meningococcal infection ranges from bacteraemia, associated with mild non-specific symptoms, to fulminant sepsis with multiorgan failure and death in approximately 10-15% of cases. Localised infections (such as conjunctivitis or septic arthritis) as well as chronic disease may be the sole clinical manifestations but can also lead to disseminated fulminant disease. Among survivors, disabling long-term sequelae can complicate meningococcal disease and result in potentially devastating effects on the quality of life of survivors, most of whom are infants, children and adolescents. The only rational approach to the prevention of meningococcal disease and the associated human suffering is through vaccination.
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Affiliation(s)
- David Pace
- Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta.
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21
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Cabellos C, Nolla JM, Verdaguer R, Pelegrin I, Ribera A, Ariza J, Viladrich PF. Arthritis related to systemic meningococcal disease: 34 years’ experience. Eur J Clin Microbiol Infect Dis 2012; 31:2661-6. [DOI: 10.1007/s10096-012-1610-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/18/2012] [Indexed: 11/28/2022]
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Ibrahim KY, Carvalho NB, Moura MLDN, Piza FMDT, Mimicos EV, Ho YL, França FODS. Infection and immune-mediated meningococcal-associated arthritis: combination features in the same patient. Rev Inst Med Trop Sao Paulo 2012; 54:109-11. [DOI: 10.1590/s0036-46652012000200009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/26/2012] [Indexed: 11/22/2022] Open
Abstract
We present a case of a 16-year-old male patient with sudden-onset, rash, arthritis and meningitis by Neisseria meningitidis one week after an acute upper respiratory infection. On the 10th day of treatment followed by neurological and arthritis clinical improvement, he presented once again a tender and swollen left knee with a moderate effusion, and active and passive range of motion was severely limited secondary to pain, and when he was submitted to surgical drainage and synovial fluid analysis he showed inflammatory characteristics. A non-steroidal anti-inflammatory drug was taken for five days with complete improvement of symptoms. The case is notable for its combination of features of septic and immune-mediated arthritis, which has rarely been reported in the same patient.
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Brandão AAGS, Prokopowitsch AS, de Campos FPF, Yoshihara LAK. Chronic meningococcemia: a rare presentation of meningococcal disease: case report. AUTOPSY AND CASE REPORTS 2012; 2:29-35. [PMID: 31528559 PMCID: PMC6735640 DOI: 10.4322/acr.2012.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/23/2012] [Indexed: 01/27/2023] Open
Abstract
Chronic meningococcemia is a rare clinical presentation within the spectrum of infections due to Neisseria -en.jpg-en.jpgmeningitidis, which was first described in 1902. It is defined as a chronic and benign meningococcal bacteremia without meningeal signs or symptoms with at least one week's duration, characterized by intermittent or continuous fever, polymorphic cutaneous rash, and migratory arthropathy. The incidence is believed to be around 1:200,000 inhabitants. It affects predominantly young people and adults, and it is equally distributed between genders. Diagnosis may be challenging in the early stages of the disease because of the difficulty in isolating Neisseria -en.jpg-en.jpgmeningitidis (it reaches 74% of positivity in advanced stages). Recently, the use of PCR for detecting Neisseria -en.jpg-en.jpgsp antigen in skin biopsies specimens has been considered for those culture-negative cases. The authors report a case of a 54-year-old female patient who sought medical attention for a five-day fever followed by arthralgia and skin lesions predominantly in the lower limbs. The patient progressed to a toxemic clinical status that improved after the administration of antibiotic therapy, which consisted of oxacillin and ceftriaxone. The diagnosis of chronic meningococcemia was performed after the isolation of Neisseria meningitidis in two different blood sample cultures. This is, to our knowledge, the first case of chronic meningococcemia described in Brazil (up to the writing of this report).
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Gottfredsson M, Reynisson IK, Ingvarsson RF, Kristjansdottir H, Nardini MV, Sigurdsson JF, Schneerson R, Robbins JB, Miller MA. Comparative long-term adverse effects elicited by invasive group B and C meningococcal infections. Clin Infect Dis 2011; 53:e117-24. [PMID: 21946191 PMCID: PMC3189164 DOI: 10.1093/cid/cir500] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Given the identity between Neisseria meningitidis serogroup B (MenB) capsular polysaccharide (polysialic acid; PSA) and PSA found on neural cell adhesion molecules, it has been proposed that infection with MenB or vaccination with PSA may be associated with subsequent autoimmune or neurological disease. METHODS We conducted 2 studies. The first was a retrospective nationwide study of invasive meningococcal disease (IMD) in Iceland (with 541 subjects) during the period 1975-2004, and we cross referenced this cohort with databases with respect to subsequent diagnosis of autoimmune disorders. A follow-up study involving 120 survivors of IMD was performed. The study included 70 patients with a history of MenB and 50 patients with N. meningitidis serogroup C (MenC) infection, who served as control subjects. Participants answered standardized questionnaires (Beck's Depression Inventory [BDI] II, Depression Anxiety Stress Scales [DASS], and Patient Health Questionnaire [PHQ]), and serum levels of immunoglobulin (Ig) G against MenB and MenC capsular polysaccharides were measured. RESULTS The nationwide cohort had 9166 patient-years of follow up. No evidence of increased autoimmunity was found to be associated with MenB, compared with MenC. In the follow-up study, patients were evaluated 16.6 years after the infection, representing 2022 patient-years of observation. Comparable rates of most complications were recorded, but MenC infections were associated with arthritis (P = .008) and migraine headaches (P = .01) more frequently than were MenB infections. No difference was observed with respect to scores on BDI-II, DASS, or PHQ. IgG anti-MenB and anti-MenC capsular polysaccharide levels were not related to patient complaints. CONCLUSIONS This study does not support the hypothesis that MenB infection may predispose to autoimmunity. MenC infections are associated with a higher prevalence of arthritis and migraine headaches. No evidence of antibody-associated pathology was detected at long-term follow-up.
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Affiliation(s)
- Magnus Gottfredsson
- Department of Medicine, The National University Hospital of Iceland, Reykjavik, Iceland.
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26
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Saldaña García N, Rumbao Aguirre J, Ulloa Santamaría E, Abad Lara J. Artritis por inmunocomplejos en la infección por meningococo. An Pediatr (Barc) 2011; 74:344-5. [DOI: 10.1016/j.anpedi.2011.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022] Open
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27
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Immune complex reaction after successful treatment of meningococcal disease: an excellent response to IVIG. Rheumatol Int 2010; 33:231-3. [PMID: 20658236 DOI: 10.1007/s00296-010-1555-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/11/2010] [Indexed: 10/19/2022]
Abstract
The convalescence phase of severe meningococcal sepsis is complicated by immune complex reactions with arthritis being the commonest. No standard guidelines exist for management of such complications, but non-steroidal anti-inflammatory drugs and steroids have been used with varying success. We report excellent response to intravenous immunoglobulin in a child with immune complex reaction following meningococcal sepsis.
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Dubos F. Stratégie de prise en charge (diagnostic, surveillance, suivi) d’une méningite présumée bactérienne de l’enfant. Med Mal Infect 2009; 39:615-28. [DOI: 10.1016/j.medmal.2009.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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30
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Meningococcal group A sepsis associated with rare manifestations and complicated by Kawasaki-like disease. Pediatr Emerg Care 2009; 25:190-2. [PMID: 19287280 DOI: 10.1097/pec.0b013e31819a8bab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neisseria meningitidis serogroup A septicemia and the development of Kawasaki disease in a 10-month-old male infant are described. The patient also experienced a number of primary/septic manifestations as consequences of the direct infectious assault and secondary/hypersensitivity immune-mediated complications. The present observation indicates an etiological relationship between invasive meningococcal infection group A and Kawasaki disease, an association in favor of superantigen-induced theory for the latter occurrence.
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Bhavnagri S, Steele N, Massasso D, Benn R, Youssef P, Bleasel J. Meningococcal-associated arthritis: infection versus immune-mediated. Intern Med J 2008; 38:71-3. [PMID: 18190423 DOI: 10.1111/j.1445-5994.2007.01560.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glikman D, Matushek SM, Kahana MD, Daum RS. Pneumonia and empyema caused by penicillin-resistant Neisseria meningitidis: a case report and literature review. Pediatrics 2006; 117:e1061-6. [PMID: 16606681 DOI: 10.1542/peds.2005-1994] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pneumonia is an uncommon manifestation of Neisseria meningitidis infection, and empyema is rarely reported. Uniform penicillin susceptibility has been assumed for meningococcal infections for many years, but decreased penicillin susceptibility has been recognized recently with increasing frequency. Breakpoints to define different categories of susceptibility were published recently by the Clinical and Laboratory Standards Institute. We report the case of a teenage girl with sepsis and extensive bilateral pneumonia with empyema caused by an N meningitidis isolate that was resistant to penicillin. Her protracted clinical course suggested that penicillin resistance contributed to her delayed recovery. Our experience with this patient suggests that susceptibility testing should be performed in every case of N meningitidis isolation, and treatment with a third-generation cephalosporin should be provided until the susceptibility results are known. Clinical suspicion of N meningitidis as a possible cause of respiratory symptoms accompanied by hypotension, even in the absence of a rash, may aid in diagnosis and therefore in the treatment and provision of prophylaxis to contacts of patients with meningococcal disease.
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Affiliation(s)
- Daniel Glikman
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA.
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Abstract
Septic arthritis has increased in incidence in the United States in the past two decades, and increasingly affects an older population with a greater burden of chronic illness and a higher risk for drug-resistant organisms. Successful management depends on a high diagnostic suspicion, empiric antibiotic treatment, and joint drainage. A bacteriologic diagnosis is more likely with inoculation into blood culture bottles than plating on solid media. As MRSA increases in prevalence in the community, empiric anti-biotic regimens increasingly need to be active against MRSA.
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Affiliation(s)
- John J Ross
- Division of Infectious Diseases, Caritas Saint Elizabeth's Medical Center, Boston, MA 02135, USA.
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van Gaalen F, Ioan-Facsinay A, Huizinga TWJ, Toes REM. The Devil in the Details: The Emerging Role of Anticitrulline Autoimmunity in Rheumatoid Arthritis. THE JOURNAL OF IMMUNOLOGY 2005; 175:5575-80. [PMID: 16237041 DOI: 10.4049/jimmunol.175.9.5575] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Rheumatoid arthritis is a chronic inflammatory autoimmune disease of unknown cause. The immune response against citrullinated Ags has recently become the prime suspect for disease pathogenesis. Immunity against citrullinated Ags is thought to play a pivotal role in the disease for several reasons: 1) citrullinated Ags are expressed in the target organ, the inflamed joint; 2) anti-citrullinated protein Abs are present before the disease becomes manifest; and 3) these Abs are highly specific for rheumatoid arthritis. In this review, data from clinical, genetic, biochemical, and animal studies is combined to create a profile of this remarkable autoantibody response. Moreover, a model is proposed of how the anti-citrullinated proteins response is generated and how it could eventually lead to chronic inflammation.
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Affiliation(s)
- Floris van Gaalen
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Faye A, Mariani-Kurkjian P, Taha MK, Louzeau C, Bingen E, Bourrillon A. Aspects cliniques et évolutifs des infections à méningocoque W135 chez l'enfant : à propos de cinq observations. Arch Pediatr 2005; 12:291-4. [PMID: 15734127 DOI: 10.1016/j.arcped.2004.11.018] [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] [Received: 12/30/2003] [Accepted: 11/12/2004] [Indexed: 11/28/2022]
Abstract
Meningococcal disease due to Neisseria meningitidis of serogroup W135 (N. meningitidis W135) is increasing in France. Clinical and outcome data concerning these infections in children are scarce. We report five cases of children hospitalized between June 2000 and December 2002 for N. meningitidis W135 infection. Extra-meningeal septic and/or non-septic complications were frequent and a prolonged post meningococcal inflammatory syndrome was reported. In N. meningitidis W135 infections a careful clinical evaluation of potential extra-meningeal complications and a long term follow up of children are needed.
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Affiliation(s)
- A Faye
- Service de pédiatrie générale, hôpital Robert-Debré, assistance publique-hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France.
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Faye A, Marianni-Kurkdjian P, Taha MK, Soussan V, Bingen E, Bourrillon A. [Meningococcal disease due to Neisseria meningitidis serogroup W135 in children. Clinical aspects and outcome]. Presse Med 2004; 33:654-7. [PMID: 15257237 DOI: 10.1016/s0755-4982(04)98708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Meningococcal disease due to Neisseria meningitidis of serogroup W135 (N. meningitidis W135) is increasing in France. Clinical and outcome data concerning these infections in children are scarce. PATIENTS We report 5 cases of children hospitalised in our unit between June 2000 and December 2002 for N. meningitidis W135 infection. CASE REPORTS Among these 5 children aged 19 months to 11 years, 3 presented with a primary meningitis and 4 with primary or secondary extra-meningeal involvement, articular in 3 cases, pericardial in 2 cases and ocular in one case. The outcome was favourable without after effects in 4 cases, marked by a resistant prolonged post-meningococcal inflammatory syndrome. COMMENTS Extra-meningeal septic and/or non septic complications are frequent and a prolonged post meningococcal inflammatory syndrome is reported. In N. meningitidis W135 infections a careful clinical evaluation of potential extra-meningeal complications and a long term follow up of children are needed.
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Affiliation(s)
- Albert Faye
- Service de pédiatrie générale, Hôpital Robert Debrxé, Paris.
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Faye A, Mariani-Kurkdjian P, Taha MK, Angoulvant F, Antonios M, Aubertin G, Soussan V, Bingen E, Bourrillon A. Clinical Features and Outcome of Pediatric Neisseria meningitidis Serogroup W135 Infection: A Report of 5 Cases. Clin Infect Dis 2004; 38:1635-7. [PMID: 15156454 DOI: 10.1086/421022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Accepted: 02/07/2004] [Indexed: 11/03/2022] Open
Abstract
We describe 5 pediatric cases of Neisseria meningitidis serogroup W135 infection. Infectious and/or reactive extrameningeal involvement was frequent. One patient had a persistent postmeningococcal inflammatory syndrome. Four of 5 isolates belonged to the clonal complex 37. The important risk of extrameningeal complications must be borne in mind when treating children with N. meningitidis W135 infection.
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Affiliation(s)
- Albert Faye
- Service de Pediatrie Generale, Hôpital Robert Debré, Paris, France.
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