Клинико-микробиологические особенности менингококковой инфекции у детей

Abstract

The threat of a pandemic of meningococcal infection, the severity of the disease and the unpredictability of outcomes necessitate monitoring of the characteristics of the disease course and the circulating serotypes of meningococcus. The purpose — to study the features of the clinical manifestations of meningococcal infection in children depending on the serogroup of N. meningitidis, as well as the phenotypic and genotypic characteristics of the pathogen. Material and methods. 97 children with invasive meningococcal infection with the established serogroup N. meningitidis, hospitalized in 2014–2020, were under observation at PRCCID. We also analyzed 15 discharge epicrises of children with invasive meningococcal infection caused by N. meningitidis W, hospitalized in hospitals in Moscow (Infectious Diseases Hospital No. 2 and Children’s City Clinical Hospital named after Z.A. Bashlyaeva) in 2017–2019. The study of the phenotypic and genotypic characteristics of the pathogen was carried out by the analysis of 34 strains of meningococcus isolated at PRCCID. Results. It was found that in the disease caused by NmW, in 29% of cases (n = 9), there was a subacute onset of the disease with a delayed appearance of an abundant hemorrhagic rash with a predominant localization on the distal extremities (p < 0,01). Also, with NmW in 22,6% (n = 7) cases, the development of convulsive syndrome is noted in 22,6% (n = 7) cases (p < 0,01). NmB is characterized (65,3%, n = 34) by multiple elements of hemorrhagic rash and the formation of soft tissue neuroses (46,2%, n = 24). Focal neurological symptoms were predominantly observed in children with HFMI caused by NmC (23,5%, n = 4) and NmW (13,3%, n = 4). It is noteworthy that among the atypical manifestations of meningococcal infection in NmW, diarrhea, pain in the abdomen and joints, myalgia were most often noted, and conjunctivitis in NmC. Intracranial complications are observed mainly in children with the disease caused by NmB (36,0%, n = 9) and NmC (24%, n = 6), extracranial — by NmB (50%, n = 5), and intracranial + extracranial — by NmW (26,8%, n = 11) and NmB (51,2%, n = 21). Analysis of the phenotypic and genotypic features of invasive meningococcal infection, depending on the pathogen, revealed meningococcal strains (54,1%, n = 20) with reduced sensitivity to antibacterial drugs, as well as 12 NmW strains (ST-11, cc11), closely located to Anglo-French and Swedish subgroup of the Hajj cluster. Conclusion. The features of the clinical manifestations of meningococcal infection in children largely depend on the serotype of the causally significant meningococcus, the timely diagnosis of which makes it possible to predict the course of the disease. It has been established that currently among circulating meningococci there are meningococcal strains with reduced sensitivity to antibacterial drugs (54,1%, n = 20), as well as NmW strains (ST-11, cc11), close to Anglo-French and Swedish subgroups of the Hajj cluster (35,3%, n = 12). This situation requires continuous monitoring of the phenotypic and genotypic characteristics of the microorganism to optimize management tactics.