Title

Clinical manifestations and course of meningococcal disease in 562 patients.

Source

Scandinavian Journal of Infectious Diseases. 28(1):47-51, 1996.

Unique Identifier

97013531

Authors

Schildkamp RL. Lodder MC. Bijlmer HA. Dankert J. Scholten RJ .

Institution

Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam,

The Netherlands.

Abstract

To describe the clinical manifestations and course of meningococcal disease (MD) data were collected on patients with

culture-proven MD, reported in the Netherlands between April 1, 1989 and April 30, 1990 by means of a

questionnaire completed by the specialist in attendance. During the study period, 562 patients (295 males, 267 females)

were reported. The age of the patients ranged from 2 weeks to 88 years. Of the patients, 57.8% were classified as

meningitic, 20.3% as bacteraemic and 21.9% as both meningitic and bacteraemic. In 4.6% of the patients a

predisposing factor was present, and in 1.4% a previous episode of meningitis had occurred. A positive family history of

meningitis was reported in 12.9% of the patients. On admission, 65.2% of the patients had haemorrhagic skin lesions,

7.9% coma and 4.2% seizures. During admission, 17.8% of the patients developed serious complications. The fatality

rate was 7.7%. In 73.2% of the deceased, death occurred within 2 days after admission. Of the survivors, 8.5%

recovered with serious sequelae. In conclusion, 16% of the patients with meningococcal disease either died or became

severely disabled. Prevention of this putative life-threatening disease seems to be the only means of circumventing the

problems caused by this serious condition.

Title

Source

Orthopaedic Nursing. 14(5):9-15; quiz 16-7, 1995 Sep-Oct.

Unique Identifier

96027348

Authors

Williamson V. Posewick J .

Abstract

Meningococcal infection can produce symptoms that have severe morbid or even fatal effects. The survival rate has

increased over the last 20 years and health care workers are now faced with managing the sequelae of cutaneous and

skeletal necroses. It is important for nurses to recognize symptoms of the disease as well as associated complications. A

multidisciplinary approach is needed to manage all phases of the illness. This phenomenon occurs most commonly in

children but may be seen in adolescents and young adults as well. Despite extensive alteration in body image and the

need for long-term rehabilitation, with proper management, a full recovery may be expected.

Title

Reasons for delay in administration of antibiotics to patients with meningitis and meningococcaemia.

Source

Journal of Infection. 32(1):49-51, 1996 Jan.

Unique Identifier

97005240

Authors

Wilks D. Lever AM .

Institution

University of Cambridge Department of Medicine, Addenbrooke's Hospital, U.K.

Abstract

To determine the extent of, and reasons for, delay in treatment of patients with bacterial meningitis or meningococcal

septicaemia, we reviewed the case notes of all adults admitted to Addenbrooke's Hospital, Cambridge with these

diagnoses over a 3 year period. Thirty-three patients were identified. Some 70% (21/30) patients admitted via their GPs

were not treated before admission. In 12 of these cases, the diagnosis was not considered. Nine patients were not

treated despite the diagnosis of meningitis being considered possible or likely; in two cases this was due to suspected

penicillin allergy, but no reason was given for the remaining seven. Of 24 patients untreated prior to hospital admission,

only nine were given antibiotics before lumbar puncture had been performed. Failure to treat meningitis and

meningococcaemia most often resulted from failure to consider the diagnosis, but treatment was delayed in a significant

number of cases for no obvious reason. General practitioners and hospital doctors need to have a low threshold for

administering antibiotics as soon as the diagnosis of bacterial meningitis or meningococcaemia is considered possible.

Title

Factors associated with fatal outcome in childhood meningococcal disease.

Source

Acta Paediatrica. 84(10):1137-42, 1995 Oct.

Unique Identifier

96157158

Authors

Flaegstad T. Kaaresen PI. Stokland T. Gutteberg T .

Institution

Department of Pediatrics, University of Tromso, Norway.

Abstract

The purpose of this study was to identify factors associated with a fatal outcome in children with meningococcal

disease and to design a new clinical scoring system. We reviewed the charts of all 137 children with meningococcal

disease admitted alive to the University Hospital, Tromso, during the years 1977-92. Twelve of the children died

(8.7%). On admission the following clinical signs were significantly associated with poor outcome: peripheral

vasoconstriction, cyanosis, extensive petechiae, hypotension, altered consciousness, hyperventilation and absence of

neck rigidity. The laboratory parameters low pH, low base excess, thrombocytopenia, low Trombotest and leukopenia

were also associated with later death. Multiple logistic regression was performed to examine the independent effect of

each variable. Cyanosis, peripheral vasoconstriction and base excess < -10 mmol/l or pH < 7.35 were significantly

associated with a fatal outcome. A clinical scoring system based on the extent of petechiae, the presence of peripheral

vasoconstriction, hyperventilation and/or cyanosis, the absence of neck rigidity and impairment of consciousness is

proposed. Twenty-nine patients received > or = 3.5 points, of whom 12 died and 12 survived. None of the patients

who died had less than 3.5 points. The clinical scoring system is based solely on clinical signs. It can be done rapidly

and performs well in identifying children who might benefit from early intensive care.

Title

Source

Archives de Pediatrie. 3(2):149-51, 1996 Feb.

Unique Identifier

96241302

Authors

Farron F. Cheseaux JJ. Pelet B .

Institution

Service de pediatrie, centre hospitalier universitaire Vaudois, Lausanne,

Suisse.

Abstract

BACKGROUND: Chronic meningococcemia, defined as a meningococcal septicemia without meningeal symptoms

with persistence of fever for at least one week prior to any antibiotics, is uncommon. Its pathophysiology remains

unclear and a defect in host immunity has been suggested.

CASE REPORT: A 15 year-old adolescent was examined because he suffered from fever for 6 days, headache,

arthralgias. A disseminated erythema led to consider the diagnosis of vascularitis that was confirmed by skin biopsy. At

day 9, blood culture yielded Neisseria meningitis group B that was confirmed by a second blood culture; the CSF was

normal and sterile. The patient was given ceftriaxone plus penicillin for 14 days and completely cured. A detailed

analysis of the complement system was negative but the patient was found to be deficient in IgA.

CONCLUSION: This is the first reported case in which chronic meningococcemia is associated with complete IgA

deficiency.

Title

The outcome of children admitted to intensive care with meningococcal septicaemia.

Source

Intensive Care Medicine. 22(3):259-63, 1996 Mar.

Unique Identifier

96276621

Authors

Mok Q. Butt W .

Institution

Intensive Care Unit, Hospitals for Sick Children, London, UK.

Abstract

OBJECTIVE: To review our experience of children with meningococcal septicaemia, and to validate, in our group,

severity scores used in different populations to predict outcome.

DESIGN: Retrospective review of case notes and charts.

PATIENTS: A total of 35 children were admitted to the paediatric intensive care unit (ICU) in the Royal Children's

Hospital (RCH) in the 8 years between January 1985 and December 1992 with proven meningococcal septicaemia.

RESULTS: Ages ranged from 4 months to 16 years, with a median age of 20 months. The median meningococcal

score was 4 and the median PRISM score was 20, with scores above these being significantly associated with death (P

< 0.0001). Thirty-two children (91%) received infusions of colloid for hypovolaemia and twenty-nine (83%) received

one or more inotropic drugs. Twenty-one children (60%) required mechanical ventilation for a median of 16.5 h (range

7-574). Seven children (20%) underwent plasmapheresis. Six children (17%) underwent haemofiltration and two (6%),

peritoneal dialysis. One patient received extracorporeal membrane oxygenation (ECMO) because of circulatory failure.

Twenty-one children (60%) developed disseminated intravascular coagulation, renal failure and/or skin or limb necrosis.

The overall survival was 66%, and all survivors are functionally normal.

CONCLUSION: The mortality from the disease remains at 34% despite the technological advances in intensive care.

The PRISM and meningococcal scores are useful in predicting outcome. Novel methods of treatment (e.g.,

plasmapheresis or ECMO) may be valuable.

Title

Source

Journal of the American Podiatric Medical Association. 86(3):129-31, 1996 Mar.

Unique Identifier

96371340

Authors

Welchon JG. Armstrong DG. Harkless LB .

Institution

Department of Orthopaedics, University of Texas Health Sciences Center, San

Antonio, USA.

Abstract

While there have been several reports of upper and lower extremity amputations secondary to meningitis and purpura

fulminans in the literature, the incidence is probably rare. Delmas et al studied five pediatric subjects with gangrene

caused by meningococcemia, with four requiring amputation. Weiner reported that all 12 patients in his review received

a lower extremity amputation, with several requiring upper extremity amputation. Joint contracture, while not as

commonly discussed as amputation, is nonetheless an important and perhaps more common finding. Urbaniak et al

indicated that of six patients reviewed, three developed significant joint contractures. With the exception of the

gangrenous changes discussed, it was joint contracture that was the most limiting factor in progression to full activity and

weightbearing in the authors' subject. Prompt, aggressive physical therapy is tantamount to effecting an acceptable

long-term outcome.

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