Lung damage in generalized meningococcal disease

The prevalence of pneumonia in generalized meningococcal disease (GMID) and its impact on the disease course remain poorly understood due to the nonspecificity of respiratory manifestations, difficulty in verifying the pathogen, and the lack of a standardized radiographic examination protocol.

The aim: to determine the incidence of lung involvement in GMID and assess its impact on the disease course and prognosis.

Materials and Methods: We analyzed the medical reports of patients with a confirmed diagnosis of GMID and chest computed tomography (CT) scans performed within 48 hours after hospitalization. Records with concomitant respiratory diseases and incomplete cases were excluded. Records were divided into groups with confirmed pneumonia and those with normal lung function. The groups were compared based on age, gender, mortality, intensive care unit (ICU) admission rate, need for respiratory support, length of hospital stay, and oxygen saturation levels. Medians, interquartile ranges, and proportions and 95% confidence intervals (CI) for qualitative variables were calculated. Differences were compared using the Mann-Whitney and Pearson chi-square tests. Differences were considered statistically significant at p ≤ 0.05.

Results. The study included 307 reports. Pneumonia was diagnosed in 54 patients (17.6%, CI 13.7-22.1%) and was characterized by a low incidence of clinical symptoms. The groups were comparable in terms of age, gender, length of hospitalization, and ICU admission rate (p>0.05). Patients with pneumonia significantly more often required prehospital respiratory support and mechanical ventilation (p<0.001). Mortality in the absence of pneumonia was 11.5% (CI 7.6-15.2), unilateral pneumonia 14.3% (CI 0-33.3), and bilateral pneumonia 42.4% (CI 25.7-60), p < 0.001.

Conclusions. Lung damage in GMID occurs in 13-22% of patients and develops concurrently with other GMID symptoms. The severity of the condition and prognosis correlate with the presence of pneumonia and the extent of lung damage. Due to the absence of respiratory symptoms in most cases, all patients with GMID should undergo lung imaging, and if lung consolidation is detected, more intensive treatment should be determined.

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