Meningococcal Infection In Children Research Articles

Systemic meningococcal infection in children of the Arkhangelsk region: predictors of unfavorable course and outcome during different periods of observation

Invasive meningococcal infection remains a leading cause of death among infectious diseases in children.Aim. to investigate predictors of death in patients with invasive meningococcal infection during two periods of observation: 1991–2011 and 2012–2022.Materials and methods. A retrospective cohort study was conducted including 143 children aged 1,5 months to 17 years old, living in the Arkhangelsk region and having had invasive meningococcal infection. The study included two periods: 1991–2011 (N=93) and 2012–2022 (N=50). Groups of recovered and deceased patients were compared.Results. When admitted to the hospital meningococcal infection or bacterial meningitis was diagnosed in 25,5% of cases among deceased patients, and in 57,3% among survivors. More than half of the patients with an fatal outcome were not referred to the hospital after the first examination by a medical professional, unlike the recovered patients, of whom 68,8% were immediately referred to the hospital after examination. The majority of the recovered patients (82.3%) were transported to medical facilities providing specialized medical care. In the deceased group, treatment was initiated in non-specialized medical facilities in 74,5% of cases due to the distance from the regional center, where specialized care is provided. Throughout the observation period, the probability of death was higher in infants, patients with of septic shock, leukopenia, in cases requiring repeated visits by medical professional, and during initial therapy in nonspecialized medical organizations. Conclusion. The need to repeatedly seek healthcare, a different referral diagnosis, delays in receiving specialized medical care and the necessity for evacuation to the regional center for specialized care, all increase the probability of death and justify the advisability of specific prevention of meningococcal infection.

Differential Diagnosis of Multisystem Inflammatory Syndrome, Influenza, Acute Coronavirus Infection COVID-19 with the Presence of Febrile Seizures and Generalized Meningococcal Infection in Children

Differential Diagnosis of Multisystem Inflammatory Syndrome, Influenza, Acute Coronavirus Infection COVID-19 with the Presence of Febrile Seizures and Generalized Meningococcal Infection in Children

Meningococcal infection in children in the period 2012–2021. Main results of a retrospective multicenter study, issues of the day

The heavy burden of meningococcal infection is associated not only with life-threatening complications in the acute period and high mortality in invasive forms of the disease, but also with severe consequences in survivors, who are not recorded in our country.The aim of study: to analyze clinical manifestations, complications of the acute period and outcomes of invasive forms of meningococcal disease in children in various regions of the Russian Federation.Materials and methods: an analysis of data from 1327 inpatient medical records of children with an invasive meningococcal infection from 14 regional centers of the Russian Federation for 2012-2021 was carried out (28.3% of cases of the disease in children in the represented federal districts).Results: it was found that young children predominated among the patients – the median was 27.4 (10.7-70.4) months. Complications of the acute period, often combined, were observed in 47.6% of cases. The development of septic shock was noted in 30.4%, Waterhouse-Friderichsen syndrome in 6.6%, carditis in 2.9%, cerebral edema in 15.7%, arthritis in 1.4% of cases; the formation of hydrocephalus, subdural effusion, sensorineural hearing loss in 1.8%, 0.6%, 1% of children, respectively. The presence of soft tissue necrosis requiring surgical intervention was noted in 3.5% of cases. Mortality rate was 10.1%. At the time of discharge from the hospital, 30% of children had complications associated with meningococcal infection: organ dysfunction/ failure in 13.2% of patients (severe in 1.3%), cerebral insufficiency in 19.6%; severe psycho-neurological deficits, sensorineural hearing loss, problems associated with the need for orthopedic/surgical interventions accounted for 0.7%, 0.6% and 0.8%, respectively.Conclusion. Considering the epidemiological features of meningococcal infection – the risk of a sharp increase in morbidity in short periods of time, the life-threatening nature of the disease itself, it is necessary to remain alert to these risks and take all possible measures to prevent the disease using all available means, the most effective of which is vaccine prevention.

Economic Burden of Invasive Meningococcal Infection in Children in the Republic of Belarus

Relevance Invasive meningococcal infection (IMI) is a significant clinical problem and is associated with a high probability of severe complications and death. Vaccination programs against meningococcus can achieve significant clinical effectiveness and require significant financial costs. This makes it relevant to study the economic burden of meningococcal infection in the conditions of modern healthcare in order to obtain basic data for subsequent research in the field of evaluation of medical technologies.Aims. To assess the economic burden of IMI in children in the conditions of healthcare in the Republic of BelarusMaterial and methods: a retrospective study using the "cost of illness" method was conducted for 22 children hospitalized in the city children's infectious clinical diseases hospital in 2018-2019. All values are presented in belarusian rubles. The average ± standard deviation, minimum – maximum values, median [Q1, Q3], cost shares (%) are calculated for the cost values. The minimum– maximum values and median [Q1, Q3] were calculated for the age of the patients.Results: taking into account the costs of treatment in healthcare organizations of all patients studied, the share of direct costs of hospitalization was 29.0%, the share of direct costs of diagnosis – 7.2%, the share of direct costs of pharmacotherapy - 8.3%. A significant part of the costs accounted for observations after discharge and amounted to 55.4%.Conclusion: a retrospective study of the economic burden of MI in the Republic of Belarus using the "cost of illness" method in patients hospitalized in a public health organization demonstrates a significant economic burden of this disease, which in the long term is primarily due to the presence of complications in the patient, as well as the impact of the patient's death on the value of total costs. The data obtained can be used in conducting national research on the evaluation of medical technologies.

Çocuklarda Meningokok Enfeksiyonlarının Klinik, Laboratuvar Bulguları ve Prognozlarının Değerlendirilmesi: Tek Merkez Deneyimi

Çocuklarda Meningokok Enfeksiyonlarının Klinik, Laboratuvar Bulguları ve Prognozlarının Değerlendirilmesi: Tek Merkez Deneyimi

Evaluation of Clinical, Laboratory Findings and Prognoses of Meningococcal Infections in Children: A Single Center Experience

Evaluation of Clinical, Laboratory Findings and Prognoses of Meningococcal Infections in Children: A Single Center Experience

THE COURSE OF GENERALIZED FORMS OF MENINGOCOCCAL INFECTION IN CHILDREN OF THE LVIV REGION DURING 2011-2019

Relevance. Meningococcal infection (MI) is one of the most significant bacterial infections in children, it is characterized by life-threatening and unpredictable fulminant course in the structure of infectious diseases.
 Objective. To analyze the clinical and laboratory features of generalized forms of MI in children of Lviv region during 2011-2019.
 Materials and methods. Retrospective analysis of 254 case reports of patients with generalized forms of MI, hospitalized in regional infectious diseases clinical hospital during 2011 -2019 years, was conducted, as well as 14 protocols for post-mortem examination of deceased from generalized forms of MI children during 2011-2019. 203 medical records with confirmed diagnosis of the disease were selected.
 Results. Meningitis as a clinical form was diagnosed in 48 children (23.6%), meningoencephalitis in 6 (3%), meningococcemia − in 82 (40.4%), combined form − in 67 children (33%).
 In children aged 1 month to 1 year and aged 1 to 3 years the combined form of the disease occurred significantly more often than the isolated clinical form. Analysis of clinical symptoms and major laboratory parameters in various clinical forms of MI were exemplified.
 12 children from 5 months up to 4 years 10 months diagnosed with MI generalized form: meningococcemia fulminant form, and one 6-year-old child with purulent meningoencephalitis had died.
 Conclusions. Despite of gradual decrease of morbidity level and respectively amount of hospitalized patients throughout 2011-2019, a difficult course of generalized forms of MI with development of toxische Schocksyndrom in 77,9% in patients with meningoccocemia were observed. Mortality in meningococcemia was 8,1%, most of the deceased were children aged 3-5 years. Misdiagnosis at the primary level were observed in 14,3%.

Improving the therapy of generalized forms of Meningococcal infection in children using extracorporeal hemocorrection

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

Клинико-микробиологические особенности менингококковой инфекции у детей

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.

Surveillance of penicillin resistance of Neisseria meningitidis strains from invasive infections between 2013 and 2018 in Turkey

Neisseria meningitidis (N. meningitidis) is regarded as the leading cause of bacterial meningitis in many regions of the world. The empiric antimicrobial treatment is mainly based on antimicrobial resistance and patient characteristics. We aimed to analyze susceptibility patterns of N. meningitidis strains isolated in Turkey. Invasive meningococci collected in a multicenter, hospital-based, epidemiological surveillance study of pediatric (0–18 years of age) bacterial meningitis cases between 2013 and 2018 were studied. Five isolates (8.7%) displayed resistance to penicillin-G, while 13 isolates (22.8%) had intermediate susceptibility. All isolates were cefotaxime and rifampin susceptible. The data shows appropriateness of third-generation cephalosporins in empirical use for meningococcal infections in children. Since Turkey is located in a transition zone geographically, surveillance reports are very crucial.

Meningococcal infection in children: factors influencing outcome

Generalized forms of meningococcal infection are characterized by high risk of complication and fatal outcomes. In Russian Federation, 2016, meningococcal infection was the second most common cause of pediatric deaths (25%) due to infectious diseases after community associated-pneumonia. Mandatory vaccination against meninococcal infection is not regulated, and immunization coverage according to epidemic indications is insufficient. During first 6–8 hours of illness clinical signs of this infection may be non-specific, because of that it is difficult to make correct diagnosis at outpatient department. Aim of the study was to analyze mistakes of diagnostics of meningococcal infection and to assess factors influencing the disease outcome. Material and methods. Retrospective cohort study was performed including 113 pediatric cases of generalized meningococcal infection occurred in Arkhangelsk region (46 cases with fatal outcome and 67 patients, who recovered). Factors influencing the outcome were recognized using Cox regression. Results. Median age of patients was 11 months. Clinical forms were meningitis (13,3%), meningococcemia (40,7%), mixed form (46%). The diagnosis of meningococcal infection was made at outpatient department in 36,9% of cases. The main causes of diagnostic mistakes were the lack of experience among primary care physicians and non-specificic symptoms during the first hours of the disease. Age younger 2 years, septic shock and time between onset of the diseases and admission to the hospital were associated with fatal outcome. Conclusion. To manage meningococcal disease we need to have good compliance with clinical guidelines for outpatient departments and hospitals; to optimize medical students education for prevention of diagnostic mistakes. Vaccination is the most effective method of prevention of deaths associated with meningococcal infection.

CLINICAL-EPIDEMIOLOGICAL FEATURES AND OUTCOME OF GENERALIZED FORMS OF MENINGOCOCCAL INFECTION IN CHILDREN

The objective of the research was to study clinical and epidemiological features and outcomes of generalized forms of meningococcal infection in children from Krasnoyarsk and Krasnoyarsk Territory during the period from 2012 to 2016. Materials and methods. A retrospective analysis of 57 medical records of hospital patients with generalized forms of meningococcal infection was carried out in the infectious and resuscitative departments of the Krasnoyarsk Clinical Hospital No. 1 from 2012 to 2016, including 12 protocols of pathologoanatomical studies of the deceased patients and 45 medical cards of ambulatory patients – convalescents of the disease from 2012 to 2016. Results. The epidemic situation for meningococcal infection in Krasnoyarsk Territory from 2012 to 2016 is characterized by signs of inter-epidemic period. Children of the first 3 years of life are in the group of high risk for the development of GFMI, which accounts for 74% of the total number of cases of children aged 14. There are signs of meningococcal infection « aging » – in the age structure the number of children in the first year of life decreased, while the proportion of children aged 4 – 7 and 7 – 14 increased compared to previous decades. There is a tendency to a decrease in the proportion of the combined forms with an increase in the frequency of « pure » meningococcemia. In recent years there has been an « atypical » course of generalized forms of the disease, when classical hemorrhagic necrotic rashes appear only on the 3rd – 4th day of the disease. In convalescents who underwent a combined form of MI and « pure » meningitis severe residual effects leading patients to disability are possible to develop. Conclusion. The use of polyvalent conjugated vaccines in potential risk groups will allow us to reduce the morbidity and mortality from generalized forms of meningococcal infection, including younger children.

Анализ летальных исходов менингококковой инфекции у детей Московской области

Анализ летальных исходов менингококковой инфекции у детей Московской области

Invasive meningococcal infections in children during the 1998–2001 hyper-endemic period in Switzerland

Pediatric cases of invasive meningococcal disease (IMD) during the 1998 to 2001, hyperendemic period in Switzerland, were investigated. Retrospective analysis of confirmed and probable cases of IMD, in patients

Meningococcal Infection in Children in the Krasnoyarsk Territory: Analysis of Fatal Outcomes

Meningococcal infection (MI) for many years has occupied one of the most important places in the structure of acute neuroinfections in children. Some decline in MI morbidity in recent years has reduced the alertness of doctors to early detection of the disease that in some cases becomes the cause of late hospitalization, development of decompensated shock and ineffective resuscitation. The purpose of the given research is to identify the causes of deaths from generalized forms of MI and the prospects of mortality reduction. The paper gives the expert analysis of 22 medical histories of children who died of generalized forms of MI during the period from 2005 to 2014 in Krasnoyarsk. The work describes the features of the clinical picture of MI generalized forms in children at the present stage, reveals the causes of deaths during the period of sporadic morbidity in the Krasnoyarsk Territory and determines the adverse prognostic features that indicate the particular severity and the development of fulminant course of the disease.

Менінгококова інфекція у дітей

Менінгококова інфекція у дітей

Altered Neutrophil Counts at Diagnosis of Invasive Meningococcal Infection in Children

Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease. Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease. Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm(3) or ≥10,000/mm(3) was present in 137 (63%), INC ≥500/mm(3) in 170 (79%) and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204 of the 216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm(3): 3 of them died and a fourth required partial amputation in all 4 limbs. Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37% of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.

Insufficient protection by Neisseria meningitidis vaccination alone during eculizumab therapy

Sirs, Spurred by the reported spectacular results of eculizumab treatment in atypical hemolytic uremic syndrome (aHUS) due to aberrations in the complement system, an increasing number of children will receive this treatment in future. The main adverse effect of this therapy is an increased susceptibility to meningococcal infection due to inhibition of the complement system’s membrane-attack complex. In patients with paroxysmal nocturnal hemoglobinuria treated with eculizumab, the reported occurrence of meningococcal infection is between 0% and 1.5% [1–3]. These data, concerning adult patients, cannot be extrapolated to children because the age-specific incidence of meningococcal disease is much higher in children. According to the medication guide of the U.S. Food and Drug Administration, a tetravalent unconjugated polysaccharide vaccine (serogroups A, C, Y, W135) has to be provided at least 2 weeks before the first dose of eculizumab. In our opinion, this approach is not sufficient for prevention in many countries, because none of the available vaccines contains a serogroup B antigen [4]. The serogroup distribution among meningococcal infections in The Netherlands is presented in Fig. 1. Since June 2002, a conjugated vaccine against serogroup C has been included in the national immunization program. In 2009, 84% of isolates belonged to serogroup B, 7% to serogroup C, and the remaining to other serogroups, such as X, Y, and W135 [5]. Thus, the advised vaccination only offers limited protection. The peak incidence of serogroup B meningococcal disease is in children younger than 5 years and between the age of 15 to 19 years. Based on the risk of meningococcal infection in children treated with eculizumab and the high prevalence of serogroup B disease that cannot yet be prevented by vaccination, penicillin prophylaxis should not only be considered [6] but strongly advised to patients. Beside this, vaccination with a conjugated vaccine might give better protection than the unconjugated polysaccharide vaccine [7]. Serogroup B prevalence is highest not only in The Netherlands but in the rest of Europe and other parts of the world [8]. The best strategy depends on the distribution of meningococcal serogroups and the availability of vaccines in different countries [9]. Fig. 1 Distribution of meningococcal serogroups 1959–2009 (adapted from Netherlands Reference Laboratory for Bacterial Meningitis, used with permission)

Review of meningococcal infection in children at a United Kingdom Hospital

Sixty-nine children were identified and evaluable. Forty-one (60%) presented with hypotension and/or abnormal neurological signs. In 34 (49%) a petechial rash was present on admission. Of note, 13 (19%) had a non-petechial rash, and rash was absent in 19 (28%). Twenty-one (30%) presented with meningism or meningitis. In one child the illness was so mild that the child was discharged prior to making a diagnosis. Five children died (7%). Sixty-three cases (91%) were diagnosed by blood or cerebrospinal fluid culture; these investigations remain the mainstay of diagnosis.

Thrombin activatable fibrinolysis inhibitor is associated with severity and outcome of severe meningococcal infection in children

In pediatric meningococcal sepsis, an imbalance between coagulation and fibrinolysis and proinflammatory action play major roles. We hypothesized that thrombin activatable fibrinolysis inhibitor (TAFI) and/or TAFI activation markers are involved in the pathogenesis of meningococcal sepsis. Children with severe meningococcal sepsis (n = 112) previously included in Rotterdam-based trials participated in this study. Clinical and laboratory parameters and severity scores were assessed. TAFI and TAFI activation markers were determined: TAFI activation peptide (TAFI-AP) and (in)activated TAFI [TAFIa(i)]. The -438G/A, Ala147Thr, and Thr325Ile polymorphisms were genotyped. TAFI levels were significantly decreased in patients with meningococcal disease at admission compared to the convalescence state. TAFI was decreased in patients with septic shock vs. those with no shock. TAFI-AP levels were increased in patients with disseminated intravascular coagulation (DIC) vs. patients without DIC. TAFI-AP and TAFIa(i) were significantly increased in non-survivors vs. survivors. TAFI-AP levels and the TAFI-AP/TAFI ratio were also strongly correlated to severity scores and laboratory parameters. The TAFI 325Ile/Ile genotype was overrepresented in patients with DIC. Activation markers of TAFI were associated with the occurrence of DIC and mortality in meningococcal sepsis patients. A determination of TAFI, TAFI-AP, and TAFIa(i) is required to enable coherent interpretation of the role of TAFI in disease.