Meningococcal Infection In Children Research Articles

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.

Multicenter Surveillance of Invasive Meningococcal Infections in Children

Meningococcal disease continues to result in substantial morbidity and mortality in children, but there is limited recent surveillance information regarding serogroup distribution and outcome in children in the United States. The objective of this study was to collect demographic, clinical, laboratory, and outcome information for infants and children who had Neisseria meningitidis infections of various serogroups and were cared for in 10 pediatric hospitals. Investigators at each of the participating hospitals identified children with meningococcal infections and collected demographic and clinical information using a standard data form. Meningococcal isolates were sent to a central laboratory for serogrouping by slide agglutination and penicillin susceptibility. From January 1, 2001, through March 15, 2005, 159 episodes of systemic meningococcal infections were detected. The greatest numbers of children were younger than 12 months (n = 41) or were 12 to 24 months of age (n = 22). Meningitis was the most common clinical manifestation of disease accounting for 112 (70%) cases; 43 (27%) children had bacteremia only. Children who were younger than 5 years (17 of 102) were significantly less likely to require mechanical ventilation than children who were 5 to 10 years of age (12 of 24) or children who were older than 10 years (13 of 33). Overall, 55 (44%) isolates were serogroup B, 32 (26%) were serogroup C, and 27 (22%) were serogroup Y. All but 1 isolate (intermediate) were susceptible to penicillin. The overall mortality rate was 8% (13 of 159) but was greater for children who were > or = 11 years of age (7 [21.2%] of 33) than for children who were younger than 11 years (6 [4.8%] of 126). Unilateral or bilateral hearing loss occurred in 14 (12.5%) of 112 children with meningitis. The morbidity and the mortality of meningococcal infections are substantial. With the recent licensure of meningococcal conjugate vaccines, our baseline trends in meningococcal disease can be compared with those seen after widespread vaccination to assess the success of routine immunization.

Severe Meningococcal Infections in Children and Adolescents

Severe Meningococcal Infections in Children and Adolescents

Prognostic utility of the semi-quantitative procalcitonin test, neutrophil count and C-reactive protein in meningococcal infection in children

The aim was to determine whether semi-quantitative procalcitonin (PCT-Q) measurements on admission can identify the severity of meningococcal infection in children. A total of 65 children (mean age 2.4 years) with meningococcal disease were included in a prospective study. All patients were treated with antibiotics, rehydration, inotropic drugs and mechanical ventilation if presenting with shock or respiratory failure. On admission, blood was drawn for routine laboratory analyses including absolute neutrophil count (NC), C-reactive protein (CRP) and PCT-Q (immunochromatographic test). A total of 33 patients presented with septic shock on admission of whom 18 developed multiple organ dysfunction syndrome (MODS) and 9 died. Forty-three patients showed a very high PCT-Q level (>or=10 ng/ml), 12 showed values between 2-9.9 ng/ml and the remaining 10 patients showed PCT-Q levels<2 ng/ml. All patients with a PCT-Q level<10 ng/ml survived, whereas all those who developed MODS or died had PCT-Q levels>or=10 ng/ml. Receiver operator curve analysis showed that PCT-Q and NC had a high predictive value for MODS and death. PCT-Q showed a sensitivity of 100%, a negative predictive value of 100% and a negative likelihood ratio of 0.0 for MODS and death. semi-quantitative procalcitonin levels under 10 ng/ml predict good outcome of children with meningococcal infection. It is a highly sensitive method to identify patients with an increased risk of multiple organ dysfunction syndrome or death.

Meningococcal infections in children from Arkansas.

Infections with Neisseria meningitidis are an important cause of morbidity and mortality in children of all ages. With wide-spread use of the heptavalent pneumococcal conjugate vaccine, this organism might become the prominent pathogen for invasive disease in children. Retrospective reviews of medical and microbiologic records from Arkansas Children's Hospital were done to identify patients with invasive N. meningitidis infections from January, 1988, through December, 2000. Basic demographic and clinical data were gathered and reviewed. Data on invasive meningococcal infections were obtained from the Arkansas Department of Health. Three hundred ninety-four cases of invasive meningococcal infection were reported to the Arkansas Department of Health during the study period. Two hundred ninety-six cases were in patients <21 years of age. The estimated annual incidence of meningococcal disease for the State of Arkansas was calculated to be 1.2-cases/100000 population during the study period. The annual incidence of meningococcal disease in patients <21 years of age was estimated at 2.9 and 21.7 cases/100000 population for children < 1 year of age. One hundred fifty patients (51%) <21 years of age with 151 episodes of invasive meningococcal infections were treated at our institution. Eighty percent of the patients were Caucasian, 55% were male, 31% live in a rural area and the median age at presentation was 30 months (range, 2 weeks to 21 years). The most common signs and symptoms at admission included fever (95%), petechial/purpuric rash (62%), nuchal rigidity (41%) and hypotension (41%). Thirty-eight patients (26%) required both inotropic support and mechanical ventilation during hospitalization, 15 patients died and 18 patients had long term sequelae. Eighty-three of the isolates were serogrouped and included the following: A (2); B (38); C (33); and Y (10). Eighty-four of the index cases were treated with parenteral cephalosporin therapy alone and did not receive additional chemoprophylaxis. Many infections in the general pediatric population are a result of N. meningitidis. Although most patients do well and recover without sequelae, there are a significant number who experience major morbidity and mortality as a result of this infection.

Treating meningococcal infections in children.

Aggressive early treatment of meningococcal disease in children can reduce mortality. This relies on prompt recognition of septicaemia and meningitis, and treatment of the complications of shock and raised intracranial pressure.

Health economics of a hexavalent meningococcal outer-membrane vesicle vaccine in children: potential impact of introduction in the Dutch vaccination program

The cost-effectiveness of universal vaccination of infants with a new hexavalent meningococcal B outer-membrane vesicle vaccine is projected for The Netherlands by applying decision analysis. The societal perspective is taken and direct and productivity costs (friction costs method) are considered. Future costs and effects are discounted at 4% (base year 1998). In this simulation model, vaccination would prevent 19 deaths and eight cases with severe long-term sequelae per year, rendering 526 additional quality adjusted life years (QALYs) per year. Yearly costs of acute phase of illness due to meningococcal infections in children are estimated at ▪ 1,426,634, while the future costs due to sequelae are estimated at ▪ 3,801,121 per year. Of all these costs, the vaccination program could prevent ▪ 3,334,052 per year. The program costs of meningococcal vaccination are estimated at ▪ 11,601,356, resulting in a cost-effectiveness ratio (CER) of ▪ 15,721 per QALY. These results are sensitive to the vaccine dose price (conservatively estimated at ▪ 10), efficacy, and coverage of meningococcal sero-subtypes.

Frequency of myocarditis in cases of fatal meningococcal infection in children: observations on 31 cases studied at autopsy.

The frequency of myocarditis associated with meningococcal disease in children was reported only in two autopsied series (United States and South Africa). Here we report the frequency of associated myocarditis in 31 children who died of meningococcal infection at Hospital Infantile N.S. da Glória in Vitória, Espirito Santo State, Brazil. The diagnosis was confirmed by isolation of Neisseria meningitidis. At least three sections of fragments of both atria and ventricles were studied using the Dallas Criteria for the morphologic diagnosis of myocarditis. The mean age was 47.6 +/- 39.8 months and the mean survival time after the onset of symptoms was 46.1 +/- 26.5 h (12-112 h). Myocarditis was present in 13 (41.9%) patients, being of minimal severity in 11 cases and of moderate severity in 2 cases. There were no cases with severe diffuse myocarditis. The frequency of myocarditis was not influenced by sex, presence of meningitis, survival time after the onset of symptoms or use of vasoactive drugs. The frequency of myocarditis reported here was intermediate between the values reported in the only two case series published in the literature (57% in the United States and 27% in South Africa). Although our data confirm the high frequency of myocarditis in meningococcal disease, further investigations are necessary to elucidate the contribution of myocarditis to myocardial dysfunction observed in cases of meningococcal infection in children.

Epidemiology of meningococcal infections in children in mid-southern part of Turkey.

59 patients were treated for meningococcal infections in Cukurova University Faculty of Medicine, Division of Pediatric Infectious Diseases. 50.8% of patients were male, 33.9% were under two years of age and 61% were under five. 78% of patients were admitted to hospital in winter and spring time. Meningococcal meningitis (MM) was present in 39% of patients on admission, however, meningococcemia in 27.1% and meningococcemia and meningococcic meningitis (Meningococcemia + MM) in 33.9%. Fatality rate was 18.6% and no association was found between mortality and clinical type of disease (p > 0.05), but mortality ratio decreased with an increasing age (p < 0.01). No deaths occurred among the 12 patients who received i.v. penicillin treatment shortly before admitting to hospital, on the other hand 11 of 47 patients (23.4%) without such a previous treatment died.

Predictors of outcome in acute meningococcal infection in children.

To develop a rapid and sensitive method for identification of patients at risk for organ system failure and death due to acute meningococcal infection, and to evaluate the reliability of the Pediatric Risk of Mortality score in predicting mortality rates from acute meningococcal infection. A prospective study which followed a retrospective analysis. The Emergency Department and pediatric intensive care unit (ICU) of a university-affiliated children's hospital. The hospital records of 86 pediatric patients with acute meningococcal infection during a 5-yr period (group 1) were reviewed. Twenty-two ICU patients (group 2) were then prospectively evaluated, and the occurrence rate of organ system failure was compared with that rate predicted by the model developed from the analysis of group 1. The occurrence of prognostic factors was compared with the development of organ system failure and death by Fisher's exact test and logistic regression analysis for patients in group 1. The mortality rates for groups 1 and 2 were compared with those rates that were predicted by the use of the Pediatric Risk of Mortality score. Eighteen of 86 patients in group 1 developed organ system failure, and seven (8.1%) patients died. Logistic regression analysis found that the combination of circulatory insufficiency, peripheral WBC counts of < 10,000 cells/mm3, and coagulopathy best predicted organ system failure. Ten of 22 patients in group 2 developed organ system failure, and two died. All patients with organ system failure exhibited > or = 1 of three identified prognostic factors. The probability of organ system failure occurring was > .5 for nine of ten patients with organ system failure. A total of nine patients in groups 1 and 2 developed multiple organ system failure, and all nine patients died. Based on Pediatric Risk of Mortality scoring, the mortality risk for nonsurvivors ranged from 27% to 94%, compared with 1% to 48% for survivors. The overall mortality rate was consistent with that rate predicted by the Pediatric Risk of Mortality scoring system. Patients with acute meningococcal infection who exhibit signs of circulatory insufficiency, a peripheral WBC count of < 10,000 cells/mm3, or a coagulopathy have a high probability of developing organ system failure. Death is highly probable when multiple organ system failure develops, and the overall mortality rate is accurately predicted by the Pediatric Risk of Mortality score.

Fatal meningococcal disease in childhood: an autopsy study of 86 cases

A retrospective study of the pathology in 86 consecutive autopsies of fatal meningococcal infection in children, performed at the Red Cross War Memorial Children's Hospital during the 19-year period from 1973 to 1991, was undertaken. The most prominent pathological changes found at autopsy were those of an overwhelming bacterial infection with evidence of disseminated intravascular coagulopathy in many organs of the body. The skin, adrenal glands and central nervous system were most commonly involved. Acute myocarditis occurred in 23 cases (27%) and was diagnosed almost exclusively histologically. In only one case was it diagnosed clinically. In addition, the nutritional status and the morphological expression of immune reactivity of our hospital population was better than expected.

Group B meningococcal infection in children during an epidemic in Cape Town, South Africa

One hundred and thirteen children with meningococcal infection were studied during an epidemic caused by N. meningitidis group B. Fifteen per cent presented with only meningeal symptoms, the remainder showed signs of septicaemia or combined septicaemia and meningitis. Sixteen per cent of the children were in shock and 18% required admission to the Intensive Care Unit (ICU). The mortality was 4.4%. More than half the children were younger than 2 years old. There was no statistical association between the age or nutritional state of the children and any of our measures of severity. A short history of symptoms was more common in children who presented with septicaemia and severe illness, who needed admission to the ICU, or who died. Diagnosis was confirmed by routine bacteriological methods and counter-immuno-electrophoresis (CIE) in 104 children. Eighty-six per cent of the isolates were group B type 2. A history of recent antibiotic treatment was associated with fewer positive cultures, but detection of meningococcal antigen by CIE was not affected by this. CIE antigen detection was not reliable because of the high incidence of false-negative results.

Catamnesis of meningococcal infection in children

The problem of rehabilitation of persons who have had meningococcal infection is relevant, and is of certain scientific and practical interest. In this work, we. we present the results of the analysis of extracts from the case histories and dispensary examination cards of 799 convalescents of meningococcal infection - 447 boys and 352 girls who underwent the disease at the age of several months / jo 15 years (348 - up to 5 years old, 278 - from 6 to 10 years old and 173 - from AND to 15 years) and came * for examination 1-2 years after discharge from the 1st infectious diseases hospital in Kazan.

Complications and sequelae of meningococcalinfections in children

Eight-six children with meningococcal meningitis or bacteremia were evaluated prospectively between 1977 and 1979 to determine the incidence of complications and features predictive of their development. The majority (83%) of these infections were caused by serogroup B strains. Twenty-seven percent of survivors experienced one or more suppurative, allergic, or neurologic complications. Hearing loss, noted in 9% of children, occurred significantly more often in patients with admission leukocytosis or leukopenia, or with CSF leukocytosis greater than 10,000/mm3 than in those with an uncomplicated course (P less than 0.01). Ten percent of survivors developed allergic complications manifested as cutaneous vasculitis or arthritis with onset five to eight days after admission. Shock, purpuric skin lesions, and fever persisting longer than five days occurred significantly more often in these children than in those who developed hearing loss or those with an uncomplicated course (P less than 0.05). Resolution of allergic complications occurred within 14 days of their onset. Compared to Neisseria meningitidis groups A and C, group B strains appear to be intermediate in their potential for allergic complications associated with childhood infection.

Meningococcal infections during infancy: confidential inquiries into 10 deaths.

The first 10 deaths from meningococcal infections in children aged under 2 years that were reported to a DHSS multicentre study were reviewed. Confidential inquiries were made of the parents, family doctors, health visitors, and hospital staff concerned with each case, and management was discussed with a paediatrician and pathologist. Diagnosis and treatment were often delayed because doctors did not realise the importance of the purpuric rash. One child died at home, and by the time they were admitted to hospital all the remaining nine were shocked and needed resuscitation. Prodromal symptoms, mainly changes in behaviour, preceded the rash in all cases. These prodromal symptoms should arouse the suspicion of septicaemia and prompt a search for petechiae so that early effective treatment may be started.

Meningococcal infections in children.

THE clinical evaluation of new antibacterial agents has resulted in varied recommendations for treatment of meningococcal infection.1 2 3 4 Clinical response to sulfonamides5 6 7 is superior to that with penicillin,8 9 10 11 12 13 and it has also been demonstrated that chloramphenicol3 and the tetracyclines14 are effective against this organism. In addition to antibacterial agents various supportive measures such as vasopressor agents and steroids are thought to be of value. Case reports2 suggest that a number of patients with the Waterhouse–Friderichsen syndrome have survived because of their use. With these facts in mind all records of patients with meningococcal infection admitted to the Los Angeles Children's Hospital . . .