Meningococcal infection in children: factors influencing outcome
https://doi.org/10.22625/2072-6732-2019-11-3-13-19
Abstract
Generalized forms of meningococcal infection are characterized by high risk of complication and fatal outcomes. In Russian Federation, 2016, meningococcal infection was the second most common cause of pediatric deaths (25%) due to infectious diseases after community associated-pneumonia. Mandatory vaccination against meninococcal infection is not regulated, and immunization coverage according to epidemic indications is insufficient. During first 6–8 hours of illness clinical signs of this infection may be non-specific, because of that it is difficult to make correct diagnosis at outpatient department.
Aim of the study was to analyze mistakes of diagnostics of meningococcal infection and to assess factors influencing the disease outcome.
Material and methods. Retrospective cohort study was performed including 113 pediatric cases of generalized meningococcal infection occurred in Arkhangelsk region (46 cases with fatal outcome and 67 patients, who recovered). Factors influencing the outcome were recognized using Cox regression.
Results. Median age of patients was 11 months. Clinical forms were meningitis (13,3%), meningococcemia (40,7%), mixed form (46%). The diagnosis of meningococcal infection was made at outpatient department in 36,9% of cases. The main causes of diagnostic mistakes were the lack of experience among primary care physicians and non-specificic symptoms during the first hours of the disease. Age younger 2 years, septic shock and time between onset of the diseases and admission to the hospital were associated with fatal outcome.
Conclusion. To manage meningococcal disease we need to have good compliance with clinical guidelines for outpatient departments and hospitals; to optimize medical students education for prevention of diagnostic mistakes. Vaccination is the most effective method of prevention of deaths associated with meningococcal infection.
About the Authors
O. V. Samodova
Northern State Medical University
Russian Federation
Arkhangelsk
Russian Federation
Arkhangelsk
E. A. Krieger
Northern State Medical University
Russian Federation
Arkhangelsk
Russian Federation
Arkhangelsk
L. V. Titova
Northern State Medical University
Russian Federation
Arkhangelsk
Russian Federation
Arkhangelsk
O. Yu. Leonteva
Northern State Medical University
Russian Federation
Arkhangelsk
Russian Federation
Arkhangelsk
References
1. Skripchenko N.V.. Vilnits A.Ya. Meningokokkovaya infektsiya u detey. – Sankt-Peterburg: Taktik-Studio. 2015. – 840s.
2. Matthew J Thompson. Nelly Ninis. Rafael Perera. Richard Mayon-White. Claire Phillips. Linda Bailey. Anthony Harnden. David Mant. Michael Levin. Clinical recognition of meningococcal disease in children and adolescents // Lancet – 2006. – Vol. 367. – P. 397–403.
3. Stephen I. Pelton. M.D. The Global Evolution of Meningococcal Epidemiology Following the Introduction of Meningococcal Vaccines // Journal of Adolescent Health – 2016. – Vol. 59 – P. 3-11.
4. Dretler A. W.. Rouphael N. G.. Stephens D. S. Progress toward the global control of Neisseria meningitidis: 21st century vaccines. current guidelines. and challenges for future vaccine development // Human Vaccines & Immunotherapeutics. – 2018. – Vol. 0. – P. 1–15. https://doi.org/10.1080/21645515.2018.1451810
5. Polibin R.V.. Mindlina A.Ya.. Gerasimov A.A.. Briko N.I. Sravnitelnyy analiz prichin smertnosti ot infektsionnykh bolezney v Rossiyskoy Federatsii i nekotorykh stranakh Evropy // Epidemiologiya i Vaktsinoprofilaktika. – 2017. – №3 (94). – S.4-10.
6. Kriger E.A.. Samodova O.V.. Rogushina N.L.. Borisova T.A.Otnosheniye roditeley k vaktsinatsii detey i faktory. svyazannyye s otkazom ot privivok // Pediatriya. Zhurnal im. G.N. Speranskogo. – 2016. – T. 95. – № 2. – S. 91-95.
7. Vazquez J.A.. Taha M.K.. Findlow J.. Gupta S.. Borrow R. Review article global Meningococcal Initiative: guidelines for diagnosis and confirmation of invasive meningococcal disease // Epidemiol. Infect. – 2016. – Vol. 144. – P. 3052–3057.
8. Lobzin Yu.V.. Skripchenko N.V.. Vilnits A.A.. Ivanova M.V.. Kvetnaya A.S.. Volkova M.O.. Sidorenko S.V.. Gostev V.V.. Kraynova T.I.. Voytenkov V.B.. Klimkin A.V. Kliniko-epidemiologicheskiye aspekty generalizovannoy meningokokkovoy infektsii u detey i podrostkov Sankt-Peterburga // Zhurnal Infektologii. – 2016. – T.8. – №1. – S. 19-25.
9. Mariette C. Lodder. Regina L. Schildkamp. Bijlmer H. A.. Dankert J.. Kuiki D. J.. Scholtens R. J. P. M. Prognostic indicators of the outcome of meningococcal disease: a study of 562 patients // J. Med. Microbiol. – 1996. – Vol. 45. – P. 16-20.
10. Kostyukova N.N.. Bekhalo V.A.. Chernyshova T.F. Meningokokkovaya infektsiya v Rossii: proshloye i blizhayshiye perspektivy // Epidemiologiya i infektsionnyye bolezni. 2014. – №2. – S.73-79.
11. Samodova O.V.. Kriger E.A.. Titova L.V.. Leontyeva O.Yu.. Sukhanov Yu.V. Iskhody generalizovannykh form meningokokkovoy infektsii u detey arkhangelskoy oblasti. 1991–2011 gg. // Zhurnal infektologii. – 2012. – № 2.– S.60-66.
12. Rychkova O.A. Vozrastnyye osobennosti immunologicheskikh narusheniy pri generalizovannykh formakh meningokokkovoy infektsii u detey // Voprosy prakticheskoy pediatrii. – 2009. – T 4. – №3. – S. 34-38.
13. Rychkova O.A.. Skripchenko N.V.. Kashuba E.A. Disfunktsii immunnoy sistemy v patogeneze razvitiya oslozhneniy meningokokkovoy infektsii u detey // Infektsionnyye bolezni. – 2009. – T. 7. – №2. – S. 32–37.
14. Darton T.. Guiver M.. Naylor S. et al. Severity of Meningococcal Disease Associated with Genomic Bacterial Load. Clin Infect Dis. – 2009. – Vol. 48. – P. 587–594.
15. Tesoro L.J.. Selbst S.M. Factors affecting outcome in meningococcal infections // Am. J. Dis Child. – 1991. – Vol. 145. – P. 218-220.
16. Putintsev A.N.. Alekseyev T.V. Keys-metod v meditsinskom obrazovanii: sovremennyye programmnyye produkty // Mezhdunarodnyy zhurnal prikladnykh i fundamentalnykh issledovaniy. – 2016. – №12. – S.1655-1659.
17. Samodova O.V.. Vasilyeva E.Yu. Klinicheskiy sluchay v obuchenii algoritma neotlozhnoy pomoshchi // Vestnik Rossiyskoy Voyenno-meditsinskoy akademii. – 2013. – № 2 (42). – S. 207-210.
18. Klinicheskiye rekomendatsii. Meningokokkovaya infektsiya u detey. God utverzhdeniya 2016. Rezhim dostupa: http://cr.rosminzdrav.ru.
19. Rtishchev A.Yu.. Koltunov I.E.. Petryaykina E.E.. Vykhristyuk O.F. Sovremennyye vozmozhnosti i perspektivy vaktsinoprofilaktiki meningokokkovoy infektsii u detey // Trudnyy patsiyent. – 2017. – T.15. – № 1-2. – S.53-58.
20. Izvekova I.Ya.. Krasnova E.I. Epidemiologiya generalizovannoy meningokokkovoy infektsii v Novosibirskoy oblasti (1992-2015) // Zhurnal infektologii. 2016. – T.8. – № 3. – S. 99-106.
Review
For citations:
Samodova O.V., Krieger E.A., Titova L.V., Leonteva O.Yu. Meningococcal infection in children: factors influencing outcome. Journal Infectology. 2019;11(3):13-19. (In Russ.) https://doi.org/10.22625/2072-6732-2019-11-3-13-19
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