Fulminant Meningococcemia Research Articles

Invasive Meningococcal Disease in North Batina, Oman in 2023. A Case Study

Invasive Meningococcal Disease is a severe bacterial infection with a high fatality rate particularly in young children. It is caused by Neisseria meningitidis bacteria which colonizes the nasopharynx. The transmission is by direct contact with droplets or discharge from an infected person or a carrier. Invasive meningococcal disease commonly presents as meningitis or meningococcemia. Acute meningococcemia progresses rapidly with a characteristic purpuric rash. Confirmation of the disease is through isolating the bacteria from sterile body fluids (CSF, blood). Early diagnosis and treatment are crucial. Recognizing purpuric rash as a late symptom of meningococcemia is important. Vaccination remains remains the best prevention. In this case study we present the details of a 12-year-old Omani child with rapidly progressive fulminant meningococcemia, leading to death.

Clinical and molecular characterization of the first culture-confirmed pediatric fulminant meningococcemia case caused by a serogroup Y clonal complex 23 strain in China

Serogroup Y Neisseria meningitidis (NmY) is rare in China, and only serogroup A and C meningococcal polysaccharide vaccines (MPVs) are included in the national vaccination schedule. We describe a case of fulminant meningococcemia caused by NmY, which occurred in a pediatric patient (2 years old) for the first time in China, confirmed by culture. Although the boy was treated in time, the dry gangrene in his toes and fingers left him with severe sequelae. An NmY isolate was cultured from the blood of the patient, and showed decreased susceptibility to penicillin (minimum inhibitory concentration of 0.125 μg/ml), with sequence type (ST) 1655 assigned to clonal complex (cc) 23. Genomic analysis showed it was clustered with isolates from Italy, UK, Finland, and South Africa, sharing designation of Y:P1.5–1,10–1:F4-1:ST-1655(cc23). The emergence of NmY invasive meningococcal disease cases challenges local immunization strategy and warrants wider usage of MPV-ACYW if there is sustained circulation of NmY.

50 Years Ago in TheJournal ofPediatrics: Heparin Therapy in Fulminant Meningococcemia

50 Years Ago in TheJournal ofPediatrics: Heparin Therapy in Fulminant Meningococcemia

Hyperbaric oxygen treatment for purpura fulminans in a child with meningococcemia

Meningococcemia may lead to purpura fulminans (PF), multiorgan failure and death unless prompt diagnosis, and treatment can not be achieved. In recent years hyperbaric oxygen treatment has been used. In the management of skin lesions developed secondary to PF. Herein we present a child whose skin lesions developed following onset of PF lesions which were resolved markedly with hyperbaric oxygen (HBO2 ) therapy. Case report: AA 6- month- 20 day- old previously healthy girl presented to our clinic with fever and generalized purpuric rash which developed within hours. On her physical examination, she was conscious but septic and agitated with 38.5 °C fever (tympanic). Glasgow Coma Score was 13. Heart beat, respiratory rate, blood pressure and O2 saturation at room air were noted as following: respectively, 160/min, 42/min, 77/45 mmHg, 96%. Initial blood tests showed anemia with high procalcitonin and C-reactive protein levels. She was started on aggressive hydration and antibiotherapy (ceftriaxone) in pediatric intensive care unit. Vasopressors and hydrocortisone were administered due to hypotension. Supportive transfusions were performed since anemia, thrombocytopenia and hypoalbuminemia had developed. HBO2 treatment was applied to necrotic lesions on her feet. Blood cultures revealed Neisseria meningitidis W 135. Her general condition improved gradually within days and she was discharged from the hospital on 28th day with recovery. A marked improvement was observed in her skin lesions, and her cranial magnetic resonance revealed regression of her bölümeeding episodes. Conclusion: Early diagnosis and appropriate intervention is crucial to decrease mortality and morbidity of fulminant meningococcemia. HBO2 treatment is highly recommended for the management of PF.

Fulminant Meningococcemia Presenting as Acute Gastroenteritis

Fulminant Meningococcemia Presenting as Acute Gastroenteritis

Fulminant Meningococcemia with meningococcal meningitis in a neonate - A case report

Although meningococcal meningitis is fairly common in children, in neonate, it is rare with systemic involvement presumably because of transplacental passage of protective maternal antibodies. The diagnosis depends on a combination of clinical examination, including fever, refusal to feed, convulsions and the typical rash, and pathological and microbiological confirmation of the disease. Outcome of the disease may be fatal if timely intervention not done. In the literature, very few cases of neonatal meningococcal disease have been reported in the India. We are reporting a 14‑day‑old neonate who developed meningococcemia with meningococcal meningitis on the 9 th day of life, evolving to septic shock. The blood and the cerebrospinal fluid cultures were positive for Neisseria meningitidis . The meningococcemia should be suspected as a cause of cutaneous petechiae and purpura in neonates having signs of septicemia as early identification and management of meningococcemia with meningitis in the neonate can be life‑saving.

Rapid recovery following fulminant meningococcemia complicated by myocarditis in a 15-year-old Nepalese girl: a case report

IntroductionFulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 14 days of hospitalization.Case presentationA 15-year-old girl presented with headache, fever, body ache, and diarrhea for 1 day, and ecchymotic rash over her body for 4 hours. Blood cultures confirmed infection with N. meningitidis. After 6 days in the hospital, the patient developed anasarca, elevated jugular venous pressure, and shock. The patient was managed with intravenous ceftriaxone and captopril. Over the next 3 days the patient rapidly improved and started walking.ConclusionMeningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patient’s rapid recovery from myocarditis.

Meningococcal Interaction to Microvasculature Triggers the Tissular Lesions of Purpura Fulminans

Neisseria meningitidis is a strict human pathogen that closely interacts with human endothelial cells via type IV pili in vitro. To decipher whether this interaction plays a role in vivo, we set up an experimental model of fulminant meningococcemia in human skin grafted SCID mice using the wild-type strain 2C4.3. Human skin and mouse tissues were sampled 24 hours after bacterial challenge for histopathology, immunohistochemistry and ultrastructural analysis. In all infected mice, N. meningitidis targeted the human vasculature, leading to bacterial and blood thrombi, infectious vasculitis and vascular leakage. Mouse vessels, including brain vessels, remained unaffected by the infectious and thrombotic process, and a nonpiliated Δ pilE derivative of 2C4.3 failed to target human graft vessels and to induce vascular damages. These data demonstrate that N. meningitidis targets human endothelial cells in vivo and that this interaction triggers the vascular damages that characterize purpura fulminans.

Clinical presentation of meningococcal disease in childhood.

Although relatively rare, meningococcal disease represents a global health problem being still the leading infectious cause of death in childhood with an overall mortality around 8%. Meningococcal meningitis is the most commonly recognized presentation, accounting for 80% to 85% of all reported cases of meningococcal disease (in half of these cases sepsis is also present concomitantly). The remaining 15-20% of cases are most commonly bloodstream infections only. Meningococcal serogroups A, B, and C account for most cases of meningococcal disease throughout the world. Recently, serogroups W-135 and X (predominantly in Africa) and group Y (in the United States and European countries) have emerged as important disease-causing isolates. Despite recent advances in medical management, the mortality rate of fulminant meningococcemia ranges from 15% to 30%. However, among survivors, 10-30% could have long term sequelae (i.e. sensoneural hearing loss, seizure, motor problems, hydrocephalus, mental retardation, and cognitive and behavioral problems). Considering the clinical severity of meningococcal disease, prevention represents the first approach for avoiding serious complications and possible deaths. The availability of new vaccines able to cover the emerging serotypes including A and Y as well as the availability on the market of new products that could prevent meningococcal B infection represent a great opportunity for the decrease of the burden of this complicated disease.

Abcès du tronc cérébral àNeisseria meningitidis chez une patiente de 28 ans, immunocompétente

Meningococcal disease can manifest in very different clinical situations. Meningococcal meningitis and fulminant meningococcemia (or purpura fulminans) are the most common forms of these infections, but many other manifestations can be seen including septic arthritis, pericarditis, pleurisy and conjunctivitis. Brain abscesses have also been described; they are a rare complication of meningococcal disease. We report the case of a 28-year-old immunocompetent patient who developed meningococcal infection associated with brain abscesses and oligo-arthritis.

Fatal meningococcemia

Within the past six years, a case of bothWaterhouse-Freidrichsen Syndrome and fulminant meningococcemia have presented to Union Memorial Hospital. Both cases presented in markedly different fashions, differed in microbiologic serogrouping, showed minimal histopathologic similarities; however achieved ultimately the same outcome through two different pathological pathways. The following case reports illustrate two mechanisms through which N. Meningitis may pathogenize a host, both leading to complete cardiovascular collapse in less than 12 hours.

Orthopaedic Sequelae of Childhood Meningococcemia: Management Considerations and Outcome

Patients who survive the initial acute phase of fulminant meningococcemia are at increased risk for serious orthopaedic complications. This report describes our experience with purpura fulminans related to meningococcemia, with emphasis on musculoskeletal sequelae and their treatment. We retrospectively reviewed the cases of forty-eight patients (twenty-two boys and twenty-six girls) who survived the acute phase of meningococcal septicemia and developed musculoskeletal sequelae. Early sequelae required surgical treatment within six months after the onset of sepsis and were primarily amputations. Late sequelae required surgical management six months or more following the initial infection and included growth disturbances, stump overgrowth, scar contractures, and soft-tissue and bone infections. The mean age at the onset of sepsis (and standard deviation) was 2.6 ± 3.0 years, and the mean duration of follow-up was 11.7 ± 5.1 years. The mean number of surgical procedures required was 4.4 ± 2.9 per patient. Early sequelae included amputations at a variety of levels. Upper-extremity amputations were less frequent than lower-extremity amputations. Growth disturbances in the upper extremities were less frequent than growth disturbances in the lower extremities. Stump overgrowth occurred in only eleven patients (23%) with a lower-extremity amputation. The prevalence of scar contractures in the upper extremities was similar to that in the lower extremities. Eight patients (17%) acquired soft-tissue and bone infections at the distal portion of the amputation stump, at a mean of 7.2 ± 5.4 years after the initial sepsis. Thirteen patients (27%) were found to have developmental delay at the time of follow-up, and it was severe in seven of them. All patients who survive meningococcal septicemia should be followed by an orthopaedic surgeon who is experienced in pediatric limb deformities and amputations. Children requiring surgery for purpura fulminans are often limited by physical disability due to amputation, scarring, and abnormal bone growth. Despite advances in orthopaedic management, children are still at risk of developing physical and developmental limitations.

Lifetime diagnosis of adrenal hemorrhage in an infant with meningococcal infection

The generalized forms of meningococcal infection are a serious health care problem. Fulminant meningococcemia is a form of infection with extremely rapid progression and high mortality, which more frequently occurs in infants of the first year of life. Autopsy study revealed bilateral adrenal hemorrhage (hemorrhagic necrosis). Acute adrenal insufficiency requires the administration of glucocorticosteroids (GCS) in particularly severe forms of meningococcemia. However, it is unadvisable to use GCS in patients with infectious toxic shock in the absence of adrenal insufficiency as it fails to affect survival in the early period and increases death rates in the late period due to the fact that superinfections may develop. Ultrasonography may be useful in detecting adrenal hemorrhagic necrosis in a patient with meningococcal infection just on his/her admission and in making an immediate decision to initiate GCS therapy. The paper describes a case of the lifetime diagnosis of adrenal hemorrhage in a paper with fulminant meningococcemia.

Heparin-binding protein as a biomarker of circulatory failure during severe infections: A report of three cases

We report 3 cases of disease - leptospirosis, tropical malaria and fulminant meningococcaemia - associated with high serum concentrations of heparin-binding protein (HBP) and haemodynamic instability. Furthermore, HBP kinetics were observed for the first 3 days in survivors and were correlated with improvement in clinical condition.

Application of the vacuum-assisted closure in pediatric patients with orthopedic sequelae of meningococcemia: report of a case successfully treated

Patients who survive the initial acute phase of fulminant meningococcemia are at an increased risk for serious complications as a result of poor tissue perfusion. It is rare that early surgical intervention is required, as it is relatively difficult to determine the degree of tissue loss early on. Once the patient is stable, debridement of all necrotic tissue is essential and may necessitate extensive removal of skin, subcutaneous tissue, and muscle. Widespread use of the vacuum-assisted closure for complex soft tissue injuries has generally showed accelerated wound healing compared with traditional methods. We report a new possible application of the vacuum-assisted closure system in very young patients with loss of tissue as a result of purpura fulminans secondary to meningococcemia.

Prise en charge périnatale et devenir neurologique à moyen terme des nouveau-nés hospitalisés pour maladie hémolytique par immunisation anti-D

Objectives To evaluate perinatal management and neurological outcome in a group of infants born with Rhesus fetomaternal allo-immunization. Patients and methods Between 1 January and 31 December 2005, all newborns admitted to neonatal unit of Rouen tertiary centre for Rhesus hemolytic disease were included in a retrospective study and divided in two groups. The newborns who were treated with intrauterine transfusion are in the group 1 and those who needed only postnatal treatment in the group 2. In each case, were considered antenatal management (ultrasonographic data, middle cerebral artery peak systolic velocity, intrauterine transfusion), postnatal treatment (phototherapy, exchange transfusion, transfusion requirements) and neurological outcome. Results Among 42 cases of Rhesus allo-immunization observed in six years, 28 newborns (67%) were admitted for neonatal cares. No case of fetal hydrops was noted. But 16/28 (57%) were preterm with a median term of 35 weeks gestation (32–36 weeks). In group 1 of six infants who had received intrauterine transfusion (IUT), only one (17%) needed postnatal exchange transfusion, and all six received one to three blood transfusions after their birth. In group 2 of 22 infants who did not receive IUT, 6/22 (27%) needed postnatal exchange and 18/22 (82%) of them received one to four blood transfusions. Phototherapy duration and albumin requirements were similar in both groups. Three deaths occurred, one due to necrotizing enterocolitis and the other two later on due to sudden infant death and fulminant meningococcemia. Neurological outcome of the remaining 25 children was normal. Discussion and conclusion Rhesus alloimmunization remain a situation at risk. Neonatal clinical presentation is less severe than previously described due to improvement in antenatal management. Infants required less postnatal exchange transfusion when they received intrauterine transfusion but more frequent blood transfusions.

Differential alterations in plasma colony-stimulating factor concentrations in meningococcaemia.

To determine whether circulating levels of any of the colony-stimulating factors (CSF) might contribute to the host response in severe sepsis, plasma concentrations of granulocyte CSF (G-CSF), granulocyte-macrophage CSF (GM-CSF), and macrophage CSF (M-CSF) were measured by immunoassays in 20 subjects with meningococcaemia, a bloodstream infection caused by Neisseria meningitidis, that has proven to be a valuable model to study the responses of other inflammatory mediators during sepsis and septic shock in humans. Plasma G-CSF concentrations were transiently elevated in most subjects during the early phase of meningococcaemia, and were higher in subjects with septic shock (mean +/- s.d. = 165 +/- 142 ng/ml, n = 9) compared with those who remained normotensive (mean +/- s.d. = 7 +/- 2 ng/ml, n = 10) (P < 0.05). Peak plasma G-CSF concentrations > 10 ng/ml were associated with the development of septic shock (P < 0.01), disseminated intravascular coagulation (P < 0.01), fulminant infection (P < 0.05), and a fatal outcome (P < 0.01). Plasma GM-CSF concentrations > 1 ng/ml were briefly present in subjects with life-threatening septic shock (1-15 ng/ml, n = 5), and were strongly associated with fulminant meningococcaemia (P < 0.01). Plasma M-CSF concentrations were marginally elevated in all subjects, but were not associated with complications related to or arising from sepsis-induced organ injury. This study demonstrates that plasma levels of G-CSF, GM-CSF and M-CSF show very different responses during meningococcaemia, changes which presumably reflect the different roles played by these mediators in sepsis and, potentially, in septic shock.

Fulminant Supraglottitis fromNeisseria meningitidis

Fulminant Supraglottitis from<i>Neisseria meningitidis</i>

Staphylococcus aureusSepsis and the Waterhouse–Friderichsen Syndrome in Children

Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection, with necrotizing pneumonia and multiple-organ-system involvement. The identification of bilateral adrenal hemorrhage at autopsy was characteristic of the Waterhouse-Friderichsen syndrome, a constellation of findings usually associated with fulminant meningococcemia. The close genetic relationship among the three responsible isolates of S. aureus, one susceptible to methicillin and two resistant to methicillin, underscores the close relationship between virulent methicillin-susceptible S. aureus and methicillin-resistant S. aureus isolates now circulating in the community.

Soft-tissue reconstruction after meningococcal septicemia using a posterior tibial artery perforator flap in a 6-year-old boy

Fulminant meningococcemia can have life-threatening as well as limb-threatening complications. However, unlike other types of peripheral gangrene, areas of necrosis do not follow known anatomic vascular patterns. Instead, irregular and patchy areas of necrosis are found to exist adjacent to viable tissues. With improved critical care, more patients survive the initial insult and are referred for reconstructive procedures. In this case, a 6-year boy was diagnosed with meningococcemia-induced purpura fulminans. After stabilization, he was transferred to our facility for management of open wounds of both lower extremities and the left elbow. Soft-tissue coverage was accomplished after multiple debridements using various flaps. In particular, a defect of the right midtibia was reconstructed using a posterior tibial artery perforator-based flap with excellent results. This is the first time such a flap has been reported in association with meningococcemia in a patient of this age.