Meningococcal disease: Clinical presentation and sequelae

Pace, David; Pollard, Andrew J.

doi:10.1016/j.vaccine.2011.12.062

Cited by 266 publications

(265 citation statements)

References 89 publications

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“…Los grupos más afectados fueron hombres, y el grupo etario de 0-5 años, teniendo el grupo bajo 9 meses de edad la mayor tasa de ataque, seguido del grupo de 9 meses a niños bajo 5 años. El cuadro clínico de la EM invasora, según varios estudios, es un proceso dinámico y se presenta en un amplio espectro clínico que puede ir desde un síndrome febril hasta un cuadro de meningitis, meningococcemia o una combinación de am- bas 17 . La meningococcemia es una infección fulminante (habitualmente menor a 24 h) que suele presentarse en las primeras 4-6 h con síntomas inespecíficos, entre ellos fiebre, mialgias, coriza, odinofagia, anorexia, náuseas y/o vómitos, irritabilidad en pacientes bajo 5 años de edad y cefalea.…”

Section: Discussionunclassified

Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile

Moreno

López²,

Vergara

et al. 2013

Rev. chil. infectol.

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Section: Discussionunclassified

Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile

Moreno

López²,

Vergara

et al. 2013

Rev. chil. infectol.

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“…During epidemics carriage may increase to 18-35%. Carriage rates increase progressively with age, from less than 1% in children under 4 years old to 25% in 15-19 year olds, and up to 32% in 25 year olds, probably due to changes in social behavior 3 . Most cases of colonization are a result of exposure to asymptomatic carriers and not to patients with IMD…”

Section: Pathophysiologymentioning

confidence: 98%

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mentioning

confidence: 99%

“…The main determinant of the clinical manifestations of meningococcal disease is the extent of activation of the host innate and acquired immune response, which is affected by bacterial factors, such as the amount of circulating endotoxin and bacterial load, as well as by genetic polymorphisms in constituents of the complement system, the inflammatory response and the coagulation and fibrinolytic cascades that affect susceptibility, seve rity and outcome of the infected individual 3 . Vascular collapse and shock, highly feared complications of meningococcal disease, are related to the effects of the lipo-oligosaccharide, a powerful toxin that activates various immune cells 2,6 .…”

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confidence: 99%

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Invasive meningococcal disease

Strelow

Vidal

2013

Arq. Neuro-Psiquiatr.

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Invasive meningococcal disease (IMD) is a major public health issue due to its global distribution, potential of epidemic spread, predominant disease burden in children and adolescents, high case-fatality rates and substantial morbidity [1][2][3] . This disease presents a broad spectrum of manifestations and it is a neurological and clinical emergency that requires prompt recognition and initiation of therapy. In this article, we present a review on the epidemiology, pathophysiology, diagnosis, treatment and prevention of IMD, with focus on its neurological issues. MicrobiologyNeisseria meningitidis (N. meningitidis) is an exclusively human gram-negative diplococcus that has a great genetic variety 1 . Its genetic plasticity and phenotypic diversity are hallmarks of the meningococcus evolution, as this bacteria acquired various genes from other species of Neisseria and also from other bacterias, like Haemophilus spp. The microorganism is a frequent colonizer of the human nasopharynx and oropharynx, but can also be found in other places, like the oral mucosa, the rectum and the urogenital tract . Meningococcal virulence is related to the major outer membrane components: capsular polysaccharide, outer membrane proteins (pili, porins, Opa, Opc, meningococcal iron-acquiring proteins), and lipo-oligosaccharide (endotoxin) [4][5][6] . There are 13 serogroups of N. meningitidis based on different capsular polysaccharide structures, but only six serogroups (A, B, C, W-135, Y and more recently X) cause most life-threatening disease 2,6,7 .Instituto de Infectologia Emílio Ribas, São Paulo SP, Brazil.Correpondence: José Eduardo Vidal; Rua Capote Valente 688 / apto. 78; 05409-002 São Paulo SP, Brasil; E-mail: josevibe@gmail.com ABStrACt Invasive meningococcal disease (IMD) is a major public health and continues to cause substantial mortality and morbidity. Serotype C is the most frequent in Brazil. The clinical spectrum of IMD is broad (meningitis, meningococcemia or both) and the clinical evolution may be unpredictable. Main features associated with mortality are: age higher than 50 years old, seizures, shock, and meningococcemia without meningitis. Blood cultures should be obtained immediately. Lumbar puncture can be performed without previous computed tomography scan (CT) in most cases. Clinical features can be useful to predic patients where an abnormal CT scan is likely. Cerebrospinal fluid (CSF) culture and Gram stain should always be required. Latex agglutination sensitivity is highly variable. Polymerase chain reaction is specially useful when other methods are negative or delayed. Usually ceftriaxone should not be delayed while awaiting CSF study or CT. Dexamethasone can be used in meningococcal meningitis. Early suspicion of IMD and antibiotic in primary care before hospitalization, rapid transportation to a hospital, and stabilization in an intensive-care unit has substantially reduced the case-fatality rate. Vaccines against serotypes A, C, W-135, and Y are available while vaccines against serotype B are expecte...

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“…4 Entre os sobreviventes as sequelas permanentes, amputações, défices auditivos, problemas do neurodesenvolvimento e epilepsia, rondam os 25%. 1,6 A gravidade da doença meningocócica depende de vá-rios factores, nomeadamente das características do hospedeiro, do próprio gérmen e também dos cuidados médicos prestados. 7 Nos últimos anos, tem sido reconhecido o papel de orientações internacionais sobre sepsis e choque séptico, nomeadamente as publicadas em 2005 e 2009, na melhoria do prognóstico de crianças com doença invasiva meningocócica.…”

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Doença Invasiva Meningocócica em Cuidados Intensivos Pediátricos

et al. 2014

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Introduction:Meningococcal infection has a high mortality and morbidity in children. Aggressive initial shock approach, early referral, secondary transport and vaccination are potential factors with impact in reducing its mortality. Objectives were to characterize children admitted to intensive care due to invasive meningococcal disease, to evaluate their prognostic scores and mortality. Material and Methods: Observational study, with retrospective data collection. Two periods were created according to the year of admission (A: 2000-2005 and B: 2006-2011). Prognostic parameters, organ failure and mortality rates were compared in these groups. Results: 70 children were admitted with invasive meningococcal disease. When compared with other causes of admission, a decrease in the number of admissions due to invasive meningococcal disease was observed (period A: 3.4%; period B: 1.5%; p = 0.001). The presence of meningitis was 41% in period A and 29% in period B (p = 0.461). Rapidly progressive purpura occurred in 78% in period A and 50% in period B (p = 0.032). Children from period A had multi-organ failure (80%), disseminated intravascular coagulation (76%) and coma (22%) more frequently than children from period B (29%, 29%, 0%; p < 0.05). Mortality was 26% in period A and 0% in period B (p = 0.006) and standardized mortality by PRISM was 1.3 and 0 in period A and B respectively. Discussion: The decrease in the number of admissions due to invasive meningococcal disease can be explained by the introduction of anti-meningococcal C vaccine in 2006. Mortality decline can be possibly explained by an improvement in the initial patient stabilization and to secondary transport. Conclusion:A decrease in the number of admissions due to invasive meningococcal disease and in mortality was observed.

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Meningococcal disease: Clinical presentation and sequelae

Cited by 266 publications

References 89 publications

Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile

Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile

Invasive meningococcal disease

Doença Invasiva Meningocócica em Cuidados Intensivos Pediátricos

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