1887

Abstract

To assess prognostic indicators of a fatal outcome in patients with meningococcal disease, data from 562 patients with culture-proven meningococcal disease, reported in the Netherlands between 1 April 1989 and 30 April 1990, were collected prospectively by means of a questionnaire completed by the specialist in attendance. Analysis was done by the test and multiple logistic regression. During the study period 43 patients (7.7%) died. The risk of a fatal outcome was increased in patients aged 0–5 months, 10–19 years, and ⩾ 50 years, in female patients and in patients presenting with coma, temperature ⩽ 38.0°, mean arterial pressure ⩽ 70 mmHg, white blood cell count ⩽ 10 × 10/L and platelet count ⩽ 100 × 10/L. Predisposing factors and duration of disease before admission were significantly associated with outcome, but these associations disappeared in the multivariate analysis. Race, the administration of antibiotics prior to admission, seizures and haemorrhagic skin lesions were not associated with outcome. In conclusion age, gender, coma, temperature, mean arterial pressure, white blood cell count and platelet count were independent prognostic indicators of the outcome of meningococcal disease. The assessment of these characteristics may be helpful for the identification of high risk patients, whose prognosis might be improved by prompt transfer to an intensive care unit.

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1996-07-01
2024-04-24
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References

  1. Schwartz B., Moore P. S., Broome C. V. Global epidemiology of meningococcal disease. Clin Microbiol Rev 1989; 2: Suppl S118–124
    [Google Scholar]
  2. Andersen B. M. Mortality in meningococcal infection. Scand J Infect Dis 1978; 10:227–282
    [Google Scholar]
  3. De Wals P., Hertoghe L., Reginster G. Mortality in meningococcal disease in Belgium. J Infect 1984; 8:264–273
    [Google Scholar]
  4. Spanjaard L., Bol P., De Marie S., Zanen H. C. Association of meningococcal serogroups with the course of disease in the Netherlands, 1959–83. Bull World Health Organ 1987; 65:861–868
    [Google Scholar]
  5. Havens P. L., Garland J. S., Brook M. M., Dewitz B. A., Stremski E. S., Troshynski T. J. Trends in mortality in children hospitalized with meningococcal infections, 1957 to 1987. Pediatr Infect Dis J 1989; 8:8–11
    [Google Scholar]
  6. Tesoro L. J., Selbst S. M. Factors affecting outcome in meningococcal infections. Am J Dis Child 1991; 145:218–220
    [Google Scholar]
  7. Fakhir S., Ahmad S. H., Ahmad P. Prognostic factors influencing mortality in meningococcal meningitis. Ann Trop Paediatr 1992; 12:149–154
    [Google Scholar]
  8. Palmer S. R., Corson J., Hall R. Meningococcal disease in Wales: clinical features, outcome and public health management. J Infect 1992; 25:321–328
    [Google Scholar]
  9. Algren J. T., Lal S., Cutliff S. A., Richman B. J. Predictors of outcome in acute meningococcal infection in children. Crit Care Med 1993; 21:447–452
    [Google Scholar]
  10. Baraff L. J., Lee S. I., Schriger D. L. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 1993; 12:389–394
    [Google Scholar]
  11. Olivares R., Bouyer J., Hubert B. Risk factors for death in meningococcal disease. Path Biol 1993; 41:164–168
    [Google Scholar]
  12. Stiehm E. R., Damrosch D. S. Factors in the prognosis of meningococcal infection. Review of 63 cases with emphasis on recognition and management of the severely ill patient. J Pediatr 1966; 68:457–467
    [Google Scholar]
  13. Niklasson P.-M., Lundbergh P., Strandell T. Prognostic factors in meningococcal disease. Scand J Infect Dis 1971; 3:17–25
    [Google Scholar]
  14. Gedde-Dahl T. W., Bjark P., Høiby E. A., Høst J. H., Bruun J. N. Severity of meningococcal disease: assessment by factors and scores and implications for patient management. Rev Infect Dis 1990; 12:973–992
    [Google Scholar]
  15. Tüysüz B., Özlü I., Aji D. Y., Erginel A. Prognostic factors in meningococcal disease and a new scoring system. Acta Paediatr 1993; 82:1053–1056
    [Google Scholar]
  16. Scholten R. J. P. M., Bijlmer H. A., Poolman J. T. Meningococcal disease in the Netherlands, 1958–1990. A steady increase in the incidence since 1982 partially caused by new serotypes and subtypes of Neisseria meningitidis. Clin Infect Dis 1993; 16:237–246
    [Google Scholar]
  17. Scholten R. J. P. M., Bijlmer H. A., Valkenburg H. A., Dankert J. Patient and strain characteristics in relation to the outcome of meningococcal disease: a multivariate analysis. Epidemiol Infect 1994; 112:115–124
    [Google Scholar]
  18. Scholten R. J. P. M., Kuipers B., Valkenburg H. A., Dankert J., Zollinger W. D., Poolman J. T. Lipo-oligosaccharide immunotyping of Neisseria meningitidis by a whole-cell ELISA with monoclonal antibodies. J Med Microbiol 1994; 41:236–243
    [Google Scholar]
  19. Miettinen O. S. Theoretical epidemiology: principles of occurrence research in medicine. New York: Wiley; 1985231–233
    [Google Scholar]
  20. Spanjaard L., Bol P., Ekker W., Zanen H. C. The incidence of bacterial meningitis in the Netherlands – a comparison of three registration systems, 1977–1982. J Infect 1985; 11:259–268
    [Google Scholar]
  21. Mims C. A. The pathogenesis of infectious disease. London: Academic Press; 1987
    [Google Scholar]
  22. Garenne M. Sex differences in measles mortality: a world review. Int J Epidemiol 1994; 23:632–642
    [Google Scholar]
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