The outcome of children admitted to intensive care with meningococcal septicaemia

Mok, Quen; Butt, Warwick

doi:10.1007/bf01712247

Cited by 61 publications

(32 citation statements)

References 17 publications

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“…As estimated from 24 patients who died in the ICU of the Nijmegen University Hospital (Fig. 2) and data reported in the literature (66, 133,290,299,307,309,333), one-third of the patients with fatal disease die within 6 h after hospital admission and one-third die between 6 and 18 h. Death at a later stage is still determined by the course in the early hours, as shown by the fact that the principal cause of death after 24 h is withdrawal of treatment because of poor neurological prognosis after prolonged cerebral hypoperfusion in the early hours (313).…”

Section: Outcome Of Fulminant Meningococcal Sepsismentioning

confidence: 98%

“…General agreement exists only on two aspects: therapy should never be delayed by diagnostic procedures, and antibiotics are the cornerstone of treatment. However, treatment of shock and the use of glucocorticoids, fresh-frozen plasma, plasma exchange, and other immunomodulating or adjuvant therapies all are subject to debate (65, 222,255,259,313,361,430).…”

Section: Therapymentioning

confidence: 99%

See 1 more Smart Citation

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

Deuren¹,

Brandtzæg²,

Meer³

2000

Clinical Microbiology Reviews

398

236

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Section: Outcome Of Fulminant Meningococcal Sepsismentioning

confidence: 98%

Section: Therapymentioning

confidence: 99%

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

Deuren¹,

Brandtzæg²,

Meer³

2000

Clinical Microbiology Reviews

398

236

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“…Currently, ARDS is still a mostly fatal complication of meningococcal septic shock [1]. The correlation known to exist between the severity of the clinical symptoms, the plasma concentration of proinflammatory cytokines and mortality led to the expectation of a fatal outcome in the present case [1,11].…”

Section: Discussionmentioning

confidence: 84%

“…Acute respiratory distress syndrome (ARDS) as a complication of meningococcal septicaemia increases mortality by w50% [1]. Polymorphonuclear neutrophils (PMNs), as effector cells of the primary immune reaction, play a leading role in the pathogenesis of ARDS [2,3].…”

mentioning

confidence: 99%

Inhibition of granulocyte activation by surfactant in a 2‐yr-old female with meningococcus-induced ARDS

Tegtmeyer¹,

Möller²,

Zabel³

2002

Eur Respir J

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Inhibition of granulocyte activation by surfactant in a 2-yr-old female with meningococcus-induced ARDS. F.K. Tegtmeyer, J.Möller, P. Zabel. #ERS Journals Ltd 2002. ABSTRACT: Activated polymorphonuclear neutrophils (PMNs) play a crucial role in acute respiratory distress syndrome (ARDS) via extracellular release of reactive cell products such as elastase. Surfactant has proved valuable in restoring lung function in ARDS. The significance of its immunomodulatory properties with respect to this effect has not yet been clarified. The aim of the present study was to determine the anti-inflammatory effects of surfactant administration in an infant with ARDS.During the acute phase of ARDS in a 2-yr-old female, levels of PMN-derived elastase complexed with a 1 -protease inhibitor (E-a 1 PI) were measured in both arterial and central venous blood samples obtained simultaneously. The results were correlated with oxygen demand and plasma concentrations of tumour necrosis factor-a (TNF-a) and interleukin-6 (IL-6) after endotracheal administration of surfactant (Alveofact1 60 mg?kg?body weight -1 ). In the present case, for the first time, a higher E-a 1 PI concentration was detected in arterial blood (4.51 mg?L -1 ) than in central venous blood (2.28 mg?L -1 ). After administration of surfactant, these concentrations and the arteriovenous difference decreased, indicating that during ARDS, most PMN degranulation takes place in the pulmonary vascular bed and is inhibited by surfactant administration. Simultaneously, TNF-a and IL-6 plasma concentrations decreased within hours and lung function was restored.This local inhibition of polymorphonuclear neutrophil activation by exogenous surfactant may play a key role in the early improvement in lung function after surfactant administration.

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“…The majority of follow up studies use mortality as their main outcome measure. [3][4][5][6] Those looking at sequelae mainly consider physical problems or hearing loss and rarely obtain information by direct assessment. [7][8][9][10][11] In the only detailed prospective case-control study, Moss 12 assessed 60 survivors from the outbreak in Bolton from 1971 to 1974.…”

mentioning

confidence: 99%

Neurodevelopmental outcome in meningococcal disease: a case‐control study.

2002

Child

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Aims-To determine long term neurodevelopmental outcome following the spectrum of meningococcal infection. Methods-Between 1988 and 1990, 152 cases of meningococcal disease were recruited; 139 survived. Between 1998 and 1999, 115 survivors (83%) were evaluated, together with 115 sex and age matched controls. Standard measures of neurological function, coordination, cognition, behaviour, and hearing were used to assess neurodevelopmental status. Results-One case has spastic quadriplegia. Gross neurological examination was normal in all other cases and all controls. Five cases and no controls have significant hearing loss. Cases performed at a lower level than controls on measures of coordination, cognition, and behaviour. Four cases and no controls had major impairments. The adjusted odds ratios for moderate and minor impairments were 3.6 (95% CI 1.3 to 10.3) and 1.6 (95% CI 0.8 to 3.4) respectively. Conclusion-The majority of survivors from this cohort do not have gross neurological deficits. However, when objective measures of motor function, cognitive ability, and behaviour were applied significant detriments were found in meningococcal survivors. (Arch Dis Child 2001;85:6-11)

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The outcome of children admitted to intensive care with meningococcal septicaemia

Abstract: The mortality from the disease remains at 34% despite the technological advances in intensive care. The PRISM and meningococcal scores are useful in predicting outcome. Novel methods of treatment (e.g., plasmapheresis or ECMO) may be valuable.

Cited by 61 publications

References 17 publications

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

Inhibition of granulocyte activation by surfactant in a 2‐yr-old female with meningococcus-induced ARDS

Neurodevelopmental outcome in meningococcal disease: a case‐control study.

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