RESUMO
Abstract Neisseria meningitidis, also known as meningococcus, is a relatively uncommon cause of invasive infection, but when it occurs, it is frequently severe and potentially life-threatening. A ten-year-old female patient developed a purpuric rash with fever. Upon arrival to the pediatric intensive care department, she was unconscious and in a poor general condition. We combined treatment with antibiotics, volume resuscitation, hydrocortisone, and CytoSorb® therapy resulted in a stabilization of hemodynamics, as well as control of hyperinflammation. We observed a significant decrease in vasopressor dosage in this patient.
Assuntos
Humanos , Feminino , Criança , Doenças das Glândulas Suprarrenais , Sepse , Púrpura Fulminante/complicações , Púrpura Fulminante/terapia , Infecções Meningocócicas/complicações , Infecções Meningocócicas/terapia , Miocardite/complicações , Miocardite/terapia , Neisseria meningitidis , HemorragiaRESUMO
BACKGROUND: Invasive meningococcal disease (IMD) is an unpredictable and severe infection caused by Neisseria meningitidis . Its case fatality rate could vary from 9.7% to 26% and up to 36% of survivors may experience long-term sequelae, representing a challenge for public health. AIMED: To describe the sequelae at hospital discharge caused by IMD in children between years 2009-2019. METHODS: Cross-sectional study performed in 2 pediatric hospitals. Patients with microbiologically confirmed diagnosis of IMD from 2009 to 2019 were included. Bivariate and logistic regression analysis were performed. RESULTS: The records of 61 patients were reviewed and included. Sixty-seven percent were male, median age 9 months (interquartile range 4-27), 72% were admitted to intensive care unit. Thirty-seven (60.5%) had at least 1 sequela (75% and 37% in patients with or without meningitis, respectively). The most frequents sequelae were neurological 72%, hearing loss 32%, and osteoarticular 24%. Significant differences were found comparing patients with and without sequelae: drowsiness 67.6% versus 41.7% ( P = 0.04), irritability 67.6% versus 25% ( P = 0.01), meningeal signs 62.2% versus 29.2% ( P = 0.01). In logistic regression analysis, postdischarge follow-up had OR 21.25 (95% confidence intervals [CI]: 4.93-91.44), irritability had OR 8.53 (95% CI: 1.64-44.12), meningeal signs had OR 8.21 (95% CI: 0.71-94.05), invasive mechanical ventilation had OR 8.23 (95% CI: 0.78-85.95), meningitis plus meningococcemia OR 1.70 (95% CI: 0.18-15.67) to have sequelae, while children with meningococcemia and vomiting had a OR 0.04 (95% CI: 0.00-0.36) and OR 0.27 (95% CI: 0.03-2.14), respectively. N. meningitidis serogroup W (MenW) was isolated in 54.1% (33/61), and N. meningitidis serogroup B (MenB) in 31.1% (19/61) of cases. A significant difference was found in osteoarticular sequelae ( P = 0.05) between MenB and MenW. There was a decrease in cases after the meningococcal conjugate vaccine against serogroups A, C, W and Y was implemented (2015-2019). CONCLUSIONS: IMD remains as a public health concern. A high rate of sequelae was found in pediatric patients in our series, even in the clinical manifestations other than meningitis. Neurological sequelae were the most prevalent. Multidisciplinary follow-up protocols to reduce long-term impact must be urgently established to assess all children with IMD.
Assuntos
Meningite Meningocócica , Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis , Assistência ao Convalescente , Criança , Chile/epidemiologia , Estudos Transversais , Progressão da Doença , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Meningite Meningocócica/complicações , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Infecções Meningocócicas/complicações , Infecções Meningocócicas/epidemiologia , Alta do Paciente , Sorogrupo , VacinaçãoRESUMO
Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.
Assuntos
Artrite Infecciosa , Exantema , Infecções Meningocócicas , Neisseria meningitidis , Adulto , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Artrite Infecciosa/terapia , Oxalato de Cálcio/uso terapêutico , Humanos , Masculino , Infecções Meningocócicas/complicações , Infecções Meningocócicas/diagnóstico , Infecções Meningocócicas/tratamento farmacológicoRESUMO
Neisseria meningitidis, also known as meningococcus, is a relatively uncommon cause of invasive infection, but when it occurs, it is frequently severe and potentially life-threatening. A ten-year-old female patient developed a purpuric rash with fever. Upon arrival to the pediatric intensive care department, she was unconscious and in a poor general condition. We combined treatment with antibiotics, volume resuscitation, hydrocortisone, and CytoSorb.½ therapy resulted in a stabilization of hemodynamics, as well as control of hyperinflammation. We observed a significant decrease in vasopressor dosage in this patient.
Assuntos
Doenças das Glândulas Suprarrenais , Infecções Meningocócicas , Miocardite , Neisseria meningitidis , Púrpura Fulminante , Sepse , Criança , Feminino , Humanos , Púrpura Fulminante/complicações , Púrpura Fulminante/terapia , Miocardite/complicações , Miocardite/terapia , Infecções Meningocócicas/complicações , Infecções Meningocócicas/terapia , HemorragiaAssuntos
Humanos , Feminino , Criança , Adolescente , Adulto , Programas de Imunização , Vacinas Meningocócicas , Meningite Meningocócica/prevenção & controle , Meningite Meningocócica/transmissão , Infecções Meningocócicas/complicações , Grupos de Risco , Brasil , Medicina Baseada em Evidências , Eficácia de VacinasRESUMO
INTRODUCTION: Meningococcal disease is associated with high mortality. When acute kidney injury (AKI) occurs in patients with severe meningococcal disease, it is typically attributable to sepsis, although meningococcal disease and lipopolysaccharide release are rarely investigated. Therefore, we evaluated renal tissue in a mouse model of meningococcal disease. METHODS: Female BALB/c mice were induced to AKI by meningococcal challenge. Markers of renal function were evaluated in infected and control mice. RESULTS: In the infected mice, serum concentrations of tumor necrosis factor alpha, interferon gamma, interleukins (IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, and IL-12), and granulocyte-macrophage colony-stimulating factor were elevated, as was renal interstitial infiltration with lymphocytes and neutrophils (p < 0.01 for the latter). Histological analysis showed meningococcal microcolonies in the renal interstitium, without acute tubular necrosis. Infected mice also showed elevated renal expression of toll-like receptor 2, toll-like receptor 4, and Tamm-Horsfall protein. The expression of factors in the intrinsic pathway of apoptosis was equal to or lower than that observed in the control mice. Urinary sodium and potassium were also lower in infected mice, probably due to a tubular defect. CONCLUSION: Our findings corroborate those of other studies of AKI in sepsis. To our knowledge, this is the first time that meningococci have been identified in renal interstitium and that the resulting apoptosis and inflammation have been evaluated. However, additional studies are needed in order to elucidate the mechanisms involved.
Assuntos
Injúria Renal Aguda , Rim , Infecções Meningocócicas , Neisseria meningitidis/isolamento & purificação , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/imunologia , Injúria Renal Aguda/patologia , Animais , Modelos Animais de Doenças , Perfilação da Expressão Gênica/métodos , Fator Estimulador de Colônias de Granulócitos e Macrófagos/análise , Interleucinas/análise , Rim/imunologia , Rim/microbiologia , Rim/patologia , Infecções Meningocócicas/complicações , Infecções Meningocócicas/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Necrose , Infiltração de Neutrófilos , Receptor 2 Toll-Like/análise , Receptor 4 Toll-Like/análise , Uromodulina/análiseRESUMO
Acute petrified myocardium associated with septic shock, diagnosed by autopsy has rarely been described. A 15-year-old adolescent male was diagnosed with childhood-onset systemic lupus erythematosus. One year later, he was hospitalized with fever, myalgia, headache, arthritis, vomiting, dyspnea and was diagnosed with sepsis secondary to bronchopneumonia and meningitis. Blood culture identified Neisseria meningitidis serogroup Y. Despite antibiotics and intensive therapeutic measures, he died after 29 days of hospitalization. The autopsy revealed necrotic cardiomyocytes with dystrophic calcification and interstitial fibrosis.
Assuntos
Calcinose/etiologia , Cardiomiopatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Infecções Meningocócicas/complicações , Sepse/complicações , Adolescente , Calcinose/diagnóstico por imagem , Calcinose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Evolução Fatal , Humanos , MasculinoRESUMO
INTRODUCCIÓN: la meningitis bacteriana es una enfermedad infecciosa aguda grave, que por su letalidad y costos en atención de salud genera un alto impacto en Salud Pública. Los agentes causales más frecuentes son Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae y Listeria monocytogenes, pero poco conocemos de nuestra realidad local. MATERIALES Y MÉTODOS: estudio descriptivo, con revisión de base de datos del laboratorio de microbiología del Hospital Carlos Van Buren, obteniendo datos de los cultivos de líquido céfalo raquídeo de pacientes mayores de 15 años entre marzo de 2013 y noviembre de 2016. RESULTADOS: 128 casos de meningitis bacteriana aguda, de los cuales 17 fueron por los microorganismos objetivos del estudio, siendo el más frecuente S. pneumoniae, clínicamente un 58% se presentó sin signos meníngeos. A 30 días del diagnóstico un 35% había fallecido, la mitad de ellos inició el tratamiento antibiótico pasadas las 24 horas desde su ingreso al hospital. En el 46% la tinción gram no evidenció bacterias. DISCUSIÓN: los microorganismos clásicamente descritos como agentes causales parecen no explicar la totalidad de los cuadros de meningitis bacteriana aguda en la población adulta estudiada, la ausencia de signos meníngeos no permite descartar la sospecha diagnóstica. La mitad de los pacientes fallecidos inició el tratamiento antibiótico pasadas las primeras 24 horas.
INTRODUCTION: bacterial meningitis is a serious acute infectious disease whose lethality and elevated health costs have a serious impact on public health. The most frequent causes are Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenza and Listeria monocytogenes, but we know little of the local situation. MATERIALS AND METHODS: A descriptive study reviewing Carlos van Buren Hospital´s microbiology laboratory data base, and obtaining the details of cerebrospinal fluid cultures of patients over the age of 15 between March 2013 and November 2016. RESULTS: 128 cases of acute bacterial meningitis of which 17% were caused by the micro-organisms of study, the most frequent being Streptococcus pneumoniae. 58% of patients had no meningeal signs. At 30 days from diagnosis 35% had died, half of these having started antibiotic treatment over 24 hours after admission. 46% of the Gram stains showed no bacteria. DISCUSSION: the classical infectious agents do not appear to account for the totality of acute bacterial meningitis in the population studied. The absence of meningeal signs should not rule out the diagnosis. Half of the patients who died started antibiotic treatment after the first 24 hours.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Infecções Bacterianas/complicações , Meningites Bacterianas/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Infecções Bacterianas/epidemiologia , Haemophilus influenzae/isolamento & purificação , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/epidemiologia , Infecções por Haemophilus/complicações , Listeriose/complicações , Listeria monocytogenes/isolamento & purificação , Infecções Meningocócicas/complicações , Neisseria meningitidis/isolamento & purificaçãoRESUMO
ABSTRACT Meningococcal meningitis is a well established potential fatal infection characterized by fever, headache, petechial rash, and vomiting in the majority of cases. However, protean manifestations including abdominal pain, sore throat, diarrhea and cough, even though rare, should not be overlooked. Similarly, although disseminated infection could potentially involve various organ-targets, secondary immune related complications including joints or pericardium should be dealt with caution, since they remain unresponsive to appropriate antibiotic regimens. We hereby report the rare case of an otherwise healthy adult female, presenting with acute abdominal pain masking Neisseria meningitidis serotype B meningitis, later complicated with recurrent reactive pericarditis despite appropriate antibiotic treatment. There follows a review of current literature.
Assuntos
Humanos , Feminino , Adulto , Pericardite/microbiologia , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Abdome Agudo/microbiologia , Infecções Meningocócicas/complicações , Recidiva , Diagnóstico Diferencial , Infecções Meningocócicas/microbiologiaRESUMO
Meningococcal meningitis is a well established potential fatal infection characterized by fever, headache, petechial rash, and vomiting in the majority of cases. However, protean manifestations including abdominal pain, sore throat, diarrhea and cough, even though rare, should not be overlooked. Similarly, although disseminated infection could potentially involve various organ-targets, secondary immune related complications including joints or pericardium should be dealt with caution, since they remain unresponsive to appropriate antibiotic regimens. We hereby report the rare case of an otherwise healthy adult female, presenting with acute abdominal pain masking Neisseria meningitidis serotype B meningitis, later complicated with recurrent reactive pericarditis despite appropriate antibiotic treatment. There follows a review of current literature.