Prognosis of Meningococcal Septicaemia

Sinclair, John F.; Skeoch, C; Hallworth, D

doi:10.1016/s0140-6736(87)93067-4

Cited by 126 publications

(59 citation statements)

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“…The lack of association in the present study between phenotype and septicaemia alone and between phenotype and rapid disease progress is surprising (Van Deuren et al, 2000;Sinclair et al, 1987); it suggests that these factors may be related to host factors rather than to the pathogen itself. Our finding of an association between calendar period and prognosis, which was independent of meningococcal phenotype and age of the patient, indicates that one or more hitherto unknown factors contributed to the observed trend in CFR.…”

Section: Resultscontrasting

confidence: 70%

“…The categorization of duration of illness before admission was intended to distinguish a fulminant course, which is a well-known risk factor for fatal outcome, from the more protracted courses (Van Deuren et al, 2000;Sinclair et al, 1987). Our choice of a positive blood culture as a surrogate for septicaemia is in accordance with the definition of septicaemia, which includes a positive blood culture combined with overt clinical signs of infection (Effersøe & Nielsen, 1986).…”

Section: Resultsmentioning

confidence: 99%

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Neisseria meningitidis phenotypic markers and septicaemia, disease progress and case-fatality rate of meningococcal disease: a 20-year population-based historical follow-up study in a Danish county

Jensen

Schønheyder

Lind

et al. 2003

Journal of Medical Microbiology

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The incidence rate (IR) and case-fatality rate (CFR) of meningococcal disease increased during the late 1980s and early 1990s in North Jutland County, Denmark. We examined the hypothesis that phenotypic markers of Neisseria meningitidis are predictors of septicaemia with or without meningitis, rapid disease progress and fatal outcome of meningococcal disease and we studied whether changes in IR and CFR over time might be related to emergence or spread of certain phenotypes. This follow-up study was based on a complete registration of 413 cases of meningococcal disease in North Jutland County during 1980-99. Phenotypic markers included serogroup, serotype and serosubtype. A complete phenotype was available for 315 cases (76 %); 100 (32 %) strains were phenotype B : 15 : P1.7,16 and 31 (10 %) were C : 2a : P1.2,5. Septicaemia without meningitis was less common in cases with B : 15 : P1.7,16 and C : 2a : P1.2,5 strains. No association was found between phenotype and rapid disease progress. The overall CFR was 12 %. An increased CFR was associated with phenotypes B : 15 : P1.7,16 [odds ratio (OR) 2·8, 95 % confidence interval (CI) 1·2-18·5] and C : 2a : P1.2,5 (OR 5·2, 95 % CI 1·6-16·4) when compared with other phenotypes. The prevalence of B : 15 : P1.7,16 strains increased gradually during the study period and the CFR increased from 8 % during 1980-89 to 19 % during 1990-99, although the CFR for other phenotypes also increased. The CFR for C : 2a : P1.2,5 remained high ($20 %), but the contribution of this phenotype to the overall CFR decreased during the study period. In conclusion, phenotypes B : 15 : P1.7,16 and C : 2a : P1.2,5 were predictors of an increased CFR. The high prevalence of phenotype B : 15 : P1.7,16 contributed to increased overall IR and CFR during 1990-99.

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Section: Resultscontrasting

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Neisseria meningitidis phenotypic markers and septicaemia, disease progress and case-fatality rate of meningococcal disease: a 20-year population-based historical follow-up study in a Danish county

Jensen

Schønheyder

Lind

et al. 2003

Journal of Medical Microbiology

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“…In contrast to the sepsis syndrome, meningococcal disease is a rapidly recognisable disease and therefore several simple scores have been developed which aim to predict outcome directly after admittance [10][11][12][13][14][15][16][17][18][19][20]. Unfortunately, most meningococcal disease scoring systems have been developed based on the analysis of small, and heterogenous, patient populations.…”

Section: Introductionmentioning

confidence: 99%

Meningococcal disease: A comparison of eight severity scores in 125 children

et al. 1996

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General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 12 May 2018Intensive Care Med (1996)

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“…The clinical manifestations of sepsis should and have been graded in the past [2,15] because decisions on monitoring and on therapy depend on the severity of the disorder, especially in a potentially peracute course of the disease. We devised a new score (named: Neisseria sepsis index [NESI]), that includes parameters of cardiovascular and metabolic derangement and the symptoms of subcutaneous bleeding and/or skin necrosis.…”

Section: Introductionmentioning

confidence: 99%

Definition of a new score for severity of generalizedNeisseria meningitidis infection

et al. 1995

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Neisseria meningitidis infection may present as meningitis or as severe, fulminant sepsis. In order to classify individual patients early according to the expected course of the disease, we developed a score named Neisseria sepsis index [NESI]. The NESI was defined using the parameters heart rate, mean arterial blood pressure, base excess and presence of acute subcutaneous bleeding and/or skin necroses (minimal value [= no evidence for sepsis] NESI 0; maximum value [= most severe sepsis] NESI 8). Seventeen patients with documented, systemic N. meningitidis infection were prospectively assessed for the terminal complement complex (TCC), serum tumour necrosis factor alpha (TNF alpha) levels (as laboratory parameters for severity of sepsis) and NESI score. The evaluation was immediately performed when the patients were admitted to the hospital. The 17 patients showed the following distribution of data: NESI 0 (n = 4), NESI 1 (n = 6), NESI 2 (n = 0), NESI 3 (n = 1), NESI 4 (n = 2), NESI 5 (n = 2), NESI 6 (n = 0), NESI 7 (n = 1), NESI 8 (n = 1). Mortality was 4/17 patients, all had NESI > or = 5. TCC values ranged from 647-6461 ng/ml (normal range: 130-360 ng/ml); and was not correlated to NESI. TNF alpha values ranged from 10-910 pg/ml and were correlated to NESI (r2 = 0.71, n = 17, P < 0.001). In patients with fatal outcome, TNF alpha was 600 +/- 160 pg/ml (mean +/- SEM) and in surviving patients 130 +/- 50 pg/ml (mean +/- SEM). TNF alpha was increased in 15/17 patients when compared to normal controls (< 27 pg/ml). CONCLUSION. The NESI is based on few clinical, objective data, that are available in every hospital. NESI appears to offer an instrument: (1) for making decisions in regard to appropriate monitoring and treatment of vital organ function; and (2) for assessing the quality of care for this life-threatening infection.

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Prognosis of Meningococcal Septicaemia

Cited by 126 publications

References 4 publications

Neisseria meningitidis phenotypic markers and septicaemia, disease progress and case-fatality rate of meningococcal disease: a 20-year population-based historical follow-up study in a Danish county

Neisseria meningitidis phenotypic markers and septicaemia, disease progress and case-fatality rate of meningococcal disease: a 20-year population-based historical follow-up study in a Danish county

Meningococcal disease: A comparison of eight severity scores in 125 children

Definition of a new score for severity of generalizedNeisseria meningitidis infection

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