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Campbell H, Andrews N, Parikh S, Ribeiro S, Gray S, Lucidarme J, Ramsay ME, Borrow R, Ladhani SN. Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England. J Infect 2019; 80:182-189. [PMID: 31715210 DOI: 10.1016/j.jinf.2019.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. METHODS Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. RESULTS In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15-24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5-14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. CONCLUSIONS Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.
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Affiliation(s)
- Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London NW9 5EQ, UK
| | - Sydel Parikh
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Steve Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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Beltrami D, Guilcher P, Longchamp D, Crisinel PA. Meningococcal serogroup W135 epiglottitis in an adolescent patient. BMJ Case Rep 2018; 2018:bcr-2017-223038. [PMID: 29507021 DOI: 10.1136/bcr-2017-223038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute epiglottitis is a severe and potentially life-threatening condition. Since the implementation of Haemophilus influenzae vaccination, the number of cases of epiglottitis has decreased and the proportion of other infectious causes has increased. We report a case of acute epiglottitis in a teenager caused by Neisseria meningitidis, an unusual pathogen.
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Affiliation(s)
- Daniela Beltrami
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Guilcher
- ENT and Neck-Facial Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - David Longchamp
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Zarbock SD, DePriest KL, Koepp BM. A case report of serotype W135 Neisseria meningitidis epiglottitis in the United States and review of twelve adult cases of meningococcal epiglottitis. IDCases 2018; 14:e00466. [PMID: 30479961 PMCID: PMC6249400 DOI: 10.1016/j.idcr.2018.e00466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 11/18/2022] Open
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de Asua I, Sorrentino E. Fulminant meningococcal supraglotittis in an immunosuppressed patient. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ladhani SN, Beebeejaun K, Lucidarme J, Campbell H, Gray S, Kaczmarski E, Ramsay ME, Borrow R. Increase in Endemic Neisseria meningitidis Capsular Group W Sequence Type 11 Complex Associated With Severe Invasive Disease in England and Wales. Clin Infect Dis 2014; 60:578-85. [DOI: 10.1093/cid/ciu881] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Pinzón-Redondo H, Coronell-Rodriguez W, Díaz-Martinez I, Guzmán-Corena Á, Constenla D, Alvis-Guzmán N. Estimating costs associated with a community outbreak of meningococcal disease in a colombian Caribbean city. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2014; 32:539-548. [PMID: 25395916 PMCID: PMC4221459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$ (2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50% of the cases died; 50% of the cases were reported to have meningitis (3/6); 33% were diagnosed with meningococcaemia and myocarditis (2/6); 50% of the cases had bacteraemia (3/6); 66% of the cases had a culture specimen positive for Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$ 4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak.
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Affiliation(s)
- Hernando Pinzón-Redondo
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
- Facultad de Medicina, Universidad de Cartagena, Cartagena-Colombia
| | | | - Inés Díaz-Martinez
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
| | - Ángel Guzmán-Corena
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
| | - Dagna Constenla
- International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nelson Alvis-Guzmán
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
- Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Cartagena-Colombia
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Ozaki B, Kittai A, Chang S. Neisseria meningitidis as a cause of facial cellulitis. BMJ Case Rep 2014; 2014:bcr-2014-203774. [PMID: 24626385 DOI: 10.1136/bcr-2014-203774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old man presented with facial cellulitis and found to have Neisseria meningitidis bacteraemia with no evidence of infection outside of the facial soft tissue. He was treated with a course of intravenous ceftriaxone and transitioned to oral amoxicillin on discharge with significant improvement of his symptoms. N meningitidis is best recognised as a causal agent of bacterial meningitis. To our knowledge N meningitidis cellulitis has only been described in 12 other cases. In this case series we describe and summarise our case, along with the 12 cases already reported in the literature. We report this case series to highlight the importance of recognising N meningitidis in the differential in patients presenting with acute skin and soft tissue infections especially involving the periorbital, head and neck regions.
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Affiliation(s)
- Brent Ozaki
- The George Washington University, Washington, DC, USA
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Campsall PA, Laupland KB, Niven DJ. Severe meningococcal infection: a review of epidemiology, diagnosis, and management. Crit Care Clin 2013; 29:393-409. [PMID: 23830646 DOI: 10.1016/j.ccc.2013.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neisseria meningitidis, also known as meningococcus, is a relatively uncommon cause of invasive infection, but when it occurs it is frequently severe and potentially life threatening. Meningococcus should be considered and investigated promptly as a potentially etiologic pathogen in any patient with meningitis, or sepsis accompanied by a petechial rash. Suspected patients should receive early appropriate antimicrobial therapy concomitantly with confirmatory invasive diagnostic tests. Vaccines have reduced the incidence of infection with certain non-B meningococcal serogroups, and new serotype B vaccines are on the horizon. This article reviews the epidemiology, diagnosis, and management of severe meningococcal infections.
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Affiliation(s)
- Paul A Campsall
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, 3500 26th Avenue Northeast, Calgary, Alberta T1Y 6J4, Canada
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Richardson DK, Helderman T, Lovett P. Meningococcal Epiglottitis in a Diabetic Adult Patient: A Case Report. J Emerg Med 2012; 43:634-6. [DOI: 10.1016/j.jemermed.2010.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/16/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
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A new era in supraglottitis? An isolated UK case of supraglottitis secondary toNeisseria meningitidis. The Journal of Laryngology & Otology 2011; 125:1206-8. [DOI: 10.1017/s0022215111002027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report the first UK case of supraglottitis secondary toNeisseria meningitidis.Method:Case report with review of the current literature on supraglottitis and its aetiology.Results:An 89-year-old woman was referred with worsening symptoms of dysphagia, hoarseness and neck discomfort. After nasopharyngoscopy and neck X-ray, supraglottitis was diagnosed. Prompt treatment comprised nebulised adrenaline, oxygen therapy and intravenous antibiotics. Microbiology samples grewN meningitidis, a notifiable disease in the UK. Public health officials were informed, and full precautions and prophylactic treatment initiated for those at risk. The patient made excellent progress and was discharged several days later.Discussion and conclusion:Supraglottitis occurs in <4 per 100 000 population. Following a successful UK childhood immunisation programme, most cases occur in adults. Supraglottitis secondary toN meningitidisis exceptionally rare, with only seven other reported cases worldwide. Morbidity is exceptionally high; over 60 per cent of patients require airway intervention. To our knowledge, this is the first reported UK case of supraglottitis secondary toN meningitidis. This case highlights the important clinical, diagnostic and therapeutic interventions required to prevent complications associated with this potentially fatal condition.
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Gupta R, Levent F, Healy CM, Edwards MS. Unusual soft tissue manifestations of Neisseria meningitidis infections. Clin Pediatr (Phila) 2008; 47:400-3. [PMID: 18424564 DOI: 10.1177/0009922807310248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Soft tissue involvement is an unusual presenting feature for children with meningococcal infection. We describe 2 children, 1 with conjunctivitis and another with a thyroglossal duct cyst abscess associated with Neisseria meningitidis, and review previous reports of these entities to emphasize the broad spectrum of meningococcal disease and pertinent aspects of treatment and of prophylaxis of contacts.
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Affiliation(s)
- Ruchi Gupta
- Driscoll Children's Hospital, Corpus Christi
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Apisarnthanarak A, Pheerapiboon P, Apisarnthanarak P, Kiratisin P, Mundy LM. Fulminant Epiglottitis with Evolution to Necrotizing Soft Tissue Infections and Fasciitis due to Aeromonas hydrophila. Infection 2007; 36:94-5. [DOI: 10.1007/s15010-007-7118-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 09/12/2007] [Indexed: 10/22/2022]
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Kortepeter MG, Adams BL, Zollinger WD, Gasser RA. Fulminant supraglottitis from Neisseria meningitidis. Emerg Infect Dis 2007; 13:502-4. [PMID: 17552114 PMCID: PMC2725902 DOI: 10.3201/eid1303.061420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Brian L. Adams
- Madigan Army Medical Center, Fort Lewis, Washington, USA
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Cartolano GL, Barbier C, Arnoult L, Simon D, Ricome JL, Hayon J. Fatal acute cellulitis due to Neisseria meningitidis. J Clin Microbiol 2003; 41:3996-7. [PMID: 12904440 PMCID: PMC179831 DOI: 10.1128/jcm.41.8.3996-3997.2003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the first fatal evolution of cellulitis due to Neisseria meningitidis serogroup Y involving an 85-year-old woman. She presented with an extensive cellulitis of the left side of the face, neck, and thorax and septic shock. In spite of active antibiotic therapy, evolution was rapidly fatal.
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Affiliation(s)
- Gian-Luigi Cartolano
- Department of Microbiology, CHI Poissy-Saint-Germain-en-Laye, 78105 Saint-Germain-en-Laye, France.
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Porras MC, Martínez VC, Ruiz IM, Encinas PM, Fernandez MT, García J, Martín Martín LC. Acute cellulitis: an unusual manifestation of meningococcal disease. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2001; 33:56-9. [PMID: 11234980 DOI: 10.1080/003655401750064086] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We describe 2 patients who both developed cellulitis due to Neisseria meningitidis and review 8 other cases reported since 1966. Female patients outnumbered male patients by 8 to 2, and there were 5 children and 5 adults. Four cases were caused by the serogroup C meningococcus, 2 cases by serogroup B and 2 others by serogroup Y (the nature of the meningococcal group was not available in 2 cases). Diverse medical underlying conditions were present in 4 of the adult patients. The periorbital region (in all 5 children), limb (in 3 adults), neck (in 1 adult) and face and neck (in 1 adult) were the locations of the meningococcal cellulitis. In all 10 patients, a favorable clinical response to the antibiotic therapy was documented and no relapses occurred. These cases indicate that N. meningitidis should be considered as a causative agent of cellulitis in the appropriate clinical setting, particularly in children with signs of periorbital infection or adults with underlying diseases.
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Affiliation(s)
- M C Porras
- Service of Internal Medicine, Hospital of Laredo, Cantabria, Spain
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Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth 2000; 85:795-7. [PMID: 11094601 DOI: 10.1093/bja/85.5.795] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Epiglottitis in the adult can be fatal and should be treated with the same degree of concern and suspicion in respect of airway patency as in children. We present three cases of adult epiglottitis in which the airway was lost prior to or during the intervention of an anaesthetist. We suggest that an emphasis on conservative management is distracting and belies the serious nature of this disease.
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Affiliation(s)
- W A Ames
- Department of Anaesthesia, 1G323 University Hospital, Ann Arbor, MI 48109-0048, USA
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