Meningococcal Disease In Children Research Articles

Surveillance for Invasive Meningococcal Disease in Children, United States–Mexico Border, 2005–2008

Surveillance for Invasive Meningococcal Disease in Children, United States–Mexico Border, 2005–2008

Molecular testing of respiratory swabs aids early recognition of meningococcal disease in children

Early meningococcal disease (MD) diagnosis is difficult. We assessed rapid molecular testing of respiratory specimens. We performed genotyping of respiratory swabs, blood, and cerebrospinal fluid from children with suspected disease and nasal swabs (NSs) from matched controls. Thirty-nine of 104 suspected cases had confirmed disease. Four controls were carriers. Throat swab ctrA and porA testing for detection of disease gave a sensitivity of 81% (17/21), specificity of 100% (44/44), positive predictive value (PPV) of 100% (17/17), negative predictive value (NPV) of 92% (44/48), and relative risk of 12. NS ctrA and porA testing gave a sensitivity of 51% (20/39), specificity of 95% (62/65), PPV of 87% (20/23), NPV of 77% (62/81), and relative risk of 4. Including only the 86 NSs taken within 48 h of presentation, the results were sensitivity of 60% (18/30), specificity of 96% (54/56), PPV of 90% (18/20), NPV of 82% (54/66), and relative risk of 5. Swab type agreement was excellent (kappa 0.80, P < 0.001). There was exact phylogenetic agreement from different specimen sites for individuals. Carried genosubtypes were P1.7 and P1.21-7. Prehospital rapid molecular testing of easily obtained respiratory specimens could accelerate diagnosis of MD.

Which antibiotic first in meningococcal disease? A national survey

ObjectiveConcerns over safety when using ceftriaxone in conjunction with calcium-containing solutions, despite administering these agents through different intravenous routes at different times,1 has led to cautions from regulatory bodies.2 3...

Surveillance for Invasive Meningococcal Disease in Children, US–Mexico Border, 2005–20081

We reviewed confirmed cases of pediatric invasive meningococcal disease in Tijuana, Mexico, and San Diego County, California, USA, during 2005–2008. The overall incidence and fatality rate observed in Tijuana were similar to those found in the US, and serogroup distribution suggests that most cases in Tijuana are vaccine preventable.

A divided nation: which antibiotic first for meningococcal disease in children and infants? a national survey

Background Meningococcal bacteria isolated from cases of invasive disease in the UK remain fully sensitive to both ceftriaxone and cefotaxime. However, concerns over safety when using ceftriaxone in conjunction with calcium-containing drugs has led to cautions from regulatory bodies and guidelines. Aims To survey all paediatric units in England and Wales to ascertain their current guidelines for antibiotic prescribing for treatment of suspected meningococcal disease. Methods Anonymous postal survey of all hospitals with resident acute paediatric services in England and Wales on first line antibiotic use for suspected meningococcal disease in children and infants. Our local ethics committee deemed this audit not requiring further research committee approval. Results 223 hospitals were identified as having acute paediatric units, from which 170 (76%) responses were received. First-line antibiotic is closely split between ceftriaxone (82 units; 48%) and cefotaxime (76 units; 45%). 96 (52%) units using ceftriaxone as first line (exclusively or as either cefotaxime or ceftriaxone) have no exceptions for using it in guidelines. Few units using ceftriaxone caution specifically about concomitant calcium use (14%) or its use in younger infants (12%). Although the vast majority of units perceived that their guidelines were adhered with 84 (49%) saying always and 81 (48%) saying mostly, only 61 (36%) had conducted an audit. Conclusions Antibiotic choice is divided across England and Wales. Consequences of using calcium and ceftriaxone concomitantly are likely to be rare, but severe. Forthcoming National Institute for Health and Clinical Excellence guidelines may create consistency.

Multicenter study of meningococcal disease in children in pediatric hospitals in Argentina

Multicenter study of meningococcal disease in children in pediatric hospitals in Argentina

Diagnostic safety-netting

Missed diagnoses in general practice are inevitable. No diagnostic test or clinical decision rule in general practice is 100% sensitive. This is largely because individuals, both children and adults, present at different stages in the evolution of their illness. At an early stage classic ‘red-flag’ features of serious illness may be absent; for example, half the cases of meningococcal disease in children are missed by GPs at first presentation often because the characteristic features of the illness are yet to appear.1 Similarly at first presentation, the serious complications of an usually uncomplicated illness may not have developed; for example, dehydration in gastroenteritis or sub-dural haematoma after head injury. Safety-netting is a diagnostic strategy to deal with this situation. The term ‘safety-netting’ was introduced to general practice by Roger Neighbour who considered it a core component of the general practice consultation.2 He defined safety-netting as encompassing three questions: 1. If I'm right what do I expect to happen? 2. How will I know if I'm wrong? 3. What would I do then? However, the evidence-base is scanty and even a brief discussion with clinical colleagues will confirm that there is little agreement on how to interpret and apply diagnostic safety-netting in practice. Ruling-out serious illness often takes precedent over ruling in a particular illness in both general practice and emergency departments.3 Up to 50% of patients will not have a firm diagnosis at the end of a consultation with their GP and yet the need to rule out serious illness remains.4 Safety- netting is critically important in this situation. It is also critically important if the diagnosis is known but carries a significant risk of serious complications either in itself (for example, dehydration in gastroenteritis) or because the individual characteristics of the patient put them at particularly high risk of …

Polymerase chain reaction for diagnosis and serogrouping of meningococcal disease in children

A prospective study was performed including all children younger than 18 years with the clinical diagnosis of invasive meningococcal disease (IMD) hospitalized at the University Hospital Sant Joan de Déu in Barcelona, Spain, from January 2001 to December 2006. During the study period, 168 meningococcal disease cases were reported. Microbiologic confirmation was obtained in 118 cases. Forty-six (38.9%) of 118 cases were only detected by polymerase chain reaction (PCR); 6 patients were culture positive and PCR negative (5%). Serogroup B predominated in the 6-year period with 83.1% of the strains. A significant decrease in serogroup C was observed in the last 3 years of the study ( P = 0.029), and less common serogroups, such as serogroup A and W135, emerged. Serogroup distribution of patient diagnoses only by real-time PCR showed a similar distribution: serogroup B, 85.7%; serogroup C, 7.1%; and nontypeable serogroups, 7.1%. In conclusion, real-time PCR is more rapid and sensitive than culture for diagnosis and serogrouping of IMD.

Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity?

Few studies have examined the relationship between viral activity and bacterial invasive disease, considering both influenza virus and respiratory syncytial virus (RSV). This study aimed to assess the potential relationship between invasive pneumococcal disease (IPD), meningococcal disease (MD), and influenza virus and RSV activity in The Netherlands. Correlations were determined between population-based data on IPD and MD during 1997-2003 and influenza virus and RSV surveillance data. Incidence rate ratios of disease during periods of high influenza virus and RSV activity over the peri-seasonal and summer baseline periods were calculated. The analyses comprised 7266 and 3072 cases of IPD and MD. When data from all seasons were included, the occurrence of pneumococcal bacteraemia and MD correlated significantly with influenza virus and RSV activity both in children and adults. Periods of increased influenza virus and RSV activity showed higher rates of pneumococcal bacteraemia in older children and adults than the peri-season period. Rates of MD in children were also higher during periods of increased influenza virus activity; the same appeared true for MD in older children during periods of increased RSV activity. Although no causal relationship may be inferred from these data, they support a role for influenza virus and RSV in the pathogenesis of IPD and MD.

Invasive meningococcal disease in children in Jerusalem

Neisseria meningitidis is an important cause of childhood meningitis and septicaemia. Between 1999 and 2005, 133 invasive meningococcal disease (IMD) cases occurred in Jerusalem, 112 (84.2%) of them in children aged 0-14 years. The annual incidence rate in Jerusalem was higher than the national average (2.45+/-0.6 vs. 1.13+/-0.16/100 000 population, P=0.002). Most of the children (82.1%) were from low socio-economic Arab and Jewish ultra-orthodox communities; mortality was higher among Arab than Jewish children (1.3 vs. 0.22/100 000 person-years, P=0.004). A cluster of 10 children with severe meningococcal sepsis (three fatalities) emerged in the winter of 2003-2004. Compared to the other 102 cases in 1999-2005 both meningococcaemia (100% vs. 51%, P=0.003) and mortality (30% vs. 6.9%, P=0.014) rates were higher. Serogroup B comprised 77.6% of the bacterial isolates. Pulsed-field gel electrophoresis showed considerable variability among cluster isolates, but significant resemblance in Arab cases throughout 1999-2005. The increased susceptibility of specific sub-populations to IMD necessitates further evaluation.

Clinical Recognition of Meningococcal Disease in Children and Adolescents

Clinical Recognition of Meningococcal Disease in Children and Adolescents

Respiratory viruses do not trigger meningococcal disease in children

To determine whether the nasopharyngitis prodrome of meningococcal disease is caused by the disease itself or respiratory viral coinfection. Case control study of children with suspected meningococcal disease. Nasal swabs and a respiratory history were obtained from suspected cases and matched controls. Molecular testing for 12 respiratory viruses was used. 104 suspected cases and controls were recruited. Detection rates for respiratory viruses were 27% (28/104) for suspected cases and 29% (30/104) for controls. Rhinoviruses (43/58, 74%) and adenoviruses (14/58, 24%) occurred most frequently with 3 coinfections. 39 (38%) suspected cases were confirmed as meningococcal disease with a detection rate for respiratory viruses of 26% (10/39). No significant difference was found in the respiratory viral detection rate between this group and their controls, Odds ratio=1.0 (95% CI 0.3 to 3.3). Prodromal respiratory symptoms were significantly more likely for suspected cases (77/104, 74%) than controls (55/104, 53%), Odds ratio 2.8 (95% CI 1.4 to 6.0), but were equally common in confirmed (28/39, 72%) and unconfirmed cases (49/65, 75%), Odds ratio 0.8 (95% CI 0.3 to 2.3). This study found no evidence that respiratory viral infections contribute to the prodrome of meningococcal disease. Rhinovirus and adenovirus detection by nasal swab is common in well and unwell children.

Invasive meningococcal disease in children in Greece: comparison of serogroup A disease with disease caused by other serogroups

Although invasive meningococcal disease caused by serogroup A is not prevalent in developed countries, a considerable number of cases were recently recorded in Greece. In this study, serogroup A meningococcal disease was compared prospectively with meningococcal disease caused by other serogroups, using similar settings of testing and management during a 5-year period between 1999 and 2003. The Neisseria meningitidis serogroup was determined in 262 cases. Serogroup B predominated, accounting for 158 (60%) of the cases. Serogroup A was second most frequent (19%), followed by serogroups W135 (11%), C (8%), and Y (2%). No cases due to serogroup C were recorded during the last year of the study. Patients with serogroup A disease were older and had a milder course compared to patients infected with serogroups B or C. Toxic appearance, purpura, thrombocytopenia, abnormal coagulation tests, and the need for admission to the intensive care unit, fluid resuscitation, inotropic drugs, and mechanical ventilation were less common. Although morbidity and mortality were lower in these patients, the differences were not significant. Serogroup B is predominant in our area, and the introduction of an effective vaccine against it is a priority. Serogroup A has emerged as the second most common serogroup, but the illness associated with it is milder.

Statistics and death from meningococcal disease in children

Medical statisticians seldom directly make life and death decisions. Though I wouldn't like to have direct responsibility for making the decision to give a penicillin injection to a child with...

Diagnosing Meningococcal Disease

Infectious Diseases/Senior Members| May 01 2006 Diagnosing Meningococcal Disease AAP Grand Rounds (2006) 15 (5): 56–57. https://doi.org/10.1542/gr.15-5-56 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Diagnosing Meningococcal Disease. AAP Grand Rounds May 2006; 15 (5): 56–57. https://doi.org/10.1542/gr.15-5-56 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: meningococcal infections Source: Thompson MJ, Ninis N, Perera R, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367:397–403. Meningococcal disease occurs worldwide; in developed countries during endemic periods, the mortality can be as great as 10%.1,–5 A practitioner’s experience with meningococcal disease is often quite limited. The potential for extremely rapid progression to a severe or fatal outcome requires that physicians recognize the signs and symptoms of meningococcal disease as early in the clinical course as possible. Most pediatricians rely on textbook descriptions of classic features that usually occur relatively late in the course of meningococcal disease – purpura, meningismus, and shock – to signal the need to consider meningococcal disease when evaluating a child who is ill. This study from the University of Oxford, United Kingdom, is a retrospective review designed to assess the sequence, development, and timing... You do not currently have access to this content.

Changing the diagnostic framework of meningococcal disease

In todays Lancet Matthew Thompson and colleagues show that leg pain cold extremities and abnormal skin colour which are symptoms and signs of sepsis and shock are seen in the first 12 h of meningococcal disease whereas the classic features of haemorrhagic rash--meningism and impaired consciousness--are relatively late signs with a median onset of 13-22 h. The authors recommend that the diagnostic framework is changed to emphasise recognition of the early symptoms of sepsis (panel). Thompson and colleagues study pioneers the description of the presentation and time course of meningococcal disease in children and adolescents before admission to hospital. (excerpt)

Clinical recognition of meningococcal disease in children and adolescents

Meningococcal disease is a rapidly progressive childhood infection of global importance. To our knowledge, no systematic quantitative research exists into the occurrence of symptoms before admission to hospital. Data were obtained from questionnaires answered by parents and from primary-care records for the course of illness before admission to hospital in 448 children (103 fatal, 345 non-fatal), aged 16 years or younger, with meningococcal disease. In 373 cases, diagnosis was confirmed with microbiological techniques. The rest of the children were included because they had a purpuric rash, and either meningitis or evidence of septicaemic shock. Results were standardised to UK case-fatality rates. The time-window for clinical diagnosis was narrow. Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h. Only 165 (51%) children were sent to hospital after the first consultation. The classic features of haemorrhagic rash, meningism, and impaired consciousness developed late (median onset 13-22 h). By contrast, 72% of children had early symptoms of sepsis (leg pains, cold hands and feet, abnormal skin colour) that first developed at a median time of 8 h, much earlier than the median time to hospital admission of 19 h. Classic clinical features of meningococcal disease appear late in the illness. Recognising early symptoms of sepsis could increase the proportion of children identified by primary-care clinicians and shorten the time to hospital admission. The framework within which meningococcal disease is diagnosed should be changed to emphasise identification of these early symptoms by parents and clinicians.

Elastase and granzymes during meningococcal disease in children: correlation to disease severity

To investigate the levels of human neutrophil elastase and lymphocyte-derived granzymes A and B in relation to disease severity in children with meningococcal disease. Clinical observational cohort study. Paediatric intensive care unit. All patients with meningococcal disease during the study period were included. Blood sampling was done on the day of admission and on days 3 and 7. Assays for elastase and granzymes were done with ELISA. Sixty-one patients were included: 19 having distinct meningitis; 17 meningitis and shock; and 25 fulminant septicaemia. On admission levels of elastase were increased in all patients, being highest in those with fulminant septicaemia and lowest in those with distinct meningitis. Granzyme A (although marginally) and granzyme B levels were only increased in patients with shock. In 20 of the 28 patients admitted for > or = 3 days elastase decreased from admission ("rapid-decrease" group). In the remaining 8 patients, elastase started to decrease after 2 days ("slow-decrease" group). Patients of the "slow-decrease" group had a higher temperature up to day 4, needed more respiratory support (mean airway pressure in cm H2O on days 3 and 4: p=0.02 and p<0.01, respectively), and more circulatory support (>2 inotropic agents on day 3; p=0.04) compared with the "rapid-decrease" group. Human neutrophil elastase and granzyme B are related with disease severity during the initial phase of meningococcal disease and prolonged neutrophil activation is associated with the extent of organ dysfunction during the period thereafter.

The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases

Objective To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease.Design Case-control study of childhood deaths from meningococcal disease, comparing hospital care...

Increased Attack Rate of Meningococcal Disease in Children With a Pregnant Mother

To investigate the relationship between meningococcal disease and family composition, especially pregnancy in mothers. This was a retrospective matched case-control study. Case patients were children (aged 0-18 years) who had meningococcal disease and were admitted to our hospital from 1990 to 2002. Children who were admitted to 1 of the general pediatric wards of the hospital during the same period and did not have meningococcal disease served as control subjects. One control subject (matched according to gender, age, and year, and season of admission) was enrolled for each case patient. Parents of case patients and control subjects were asked to fill out a questionnaire on family composition, birth dates of siblings, and pregnancy at the time of hospital admission. A total of 88 matched case-control pairs were included. In the case group, 17 (19%) mothers reported having been pregnant at the time of hospitalization of their child, compared with 2 (2%) in the control group. Other family characteristics were not different. After adjustment for confounding factors, pregnancy of mothers remained a significant risk factor for meningococcal disease in children (odds ratio: 11.7; 95% confidence interval: 2.6-53.9). Meningococcal disease in children was highly associated with pregnancy of the patient's mother during hospitalization. Mechanisms by which the presence of a pregnant mother in a family affects the attack rate of meningococcal disease in her children need additional investigation.