Hypervirulent Strains of Neisseria meningitidis and Clinical Manifestations in Children With Invasive Meningococcal Disease

Abstract

Background: Hypervirulent clonal complex (cc) have been associated with higher incidence and case fatality rate of invasive meningococcal disease (IMD). The aim of this study was to describe the clinical manifestations of the hypervirulent cc of meningococcus in children. Methods: Retrospective study in patients hospitalized by IMD microbiologically confirmed at three children’s tertiary health care centers in Santiago, Chile, between 2010 and 2018. Demographic, clinical information and determination of the cc and factor H binding protein (fHbp) alleles were performed. Results: In total 93 cases were evaluated, sequence typing was available for 91 cases, and 87 (95.6%) had a cc assigned; 63.7% were MenW and 31.8% MenB. The median age was 9 months, 67% were male and 18.7% had any comorbidity. A 26.4% presented neurological deficit, 25.3% petechiae and 20% diarrhea. Sixty-seven percent were admitted to the pediatric intensive care unit (PICU) and the case fatality rate was 9.9%. Regarding cc and fHbp alleles, ST11, ST41/44 and allele 22 were the most frequently identified, with 63.7%, 19.8% and 72.5%, respectively. We found statistically significant differences between the cc and presence of petechiae, diagnosis of meningococcemia plus meningitis, admission and days in PICU and advanced support. Allele 22 for fHbp was associated with the absence of petechiae, low suspicion of IMD, less diagnosis of meningitis+meningococcemia, PICU admission, advanced support and adrenal insufficiency. Conclusion: Epidemiological and microbiological surveillance of IMD should integrate clinical and laboratory components, including molecular and genetic characterization, to enrich the dynamic understanding of the clinical evolution of IMD.

Diagnostic Performance of central nervous system infections in patients with neurosurgical intensive care using metagenomic next-generation sequencing: A Prospective Observational Study

“…(2) The patient has new changes in consciousness, increased intracranial pressure, meningeal irritation, or fever. (3) The patient has abnormal cerebrospinal fluid laboratory examination or leukocytosis. Exclusion criteria included ineligible samples, refusal of patients and their families to sign informed consent, those with preoperative complications of intracranial infection, and the clinician's opinion that the case was unsuitable for inclusion in this study.…”

“…The incidence rate of extraventricular drainage-related infection was reported to be 8% to 22%, while craniocerebral trauma and lumbar cistercius drainage were 1.4% and 5% (2). Central nervous system infections lead to high morbidity and mortality (3)(4)(5). The infections also lead to long-term implications, such as neurological deficits.…”