Related Experiment Videos
Invasive meningococcal infection in Western Australia
1Department of Paediatrics, Princess Margaret Hospital for Children, Subiaco, Western Australia.
Insights
Meningococcal infection in children presents with fever and rash, with purpura indicating higher mortality risk. Aboriginal children and infants under 3 months showed increased incidence and specific risk factors.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Clinical Microbiology
Background:
- Meningococcal infection is a significant cause of morbidity and mortality in children.
- Understanding the clinical presentation, demographic distribution, and risk factors is crucial for timely diagnosis and management.
- Previous studies have highlighted variations in disease patterns across different populations and age groups.
Purpose of the Study:
- To review the signs and symptoms of meningococcal infection in children.
- To analyze the age, sex, and race distribution of meningococcal infections.
- To assess the association between presenting features and patient outcomes, including morbidity and mortality.
Main Methods:
- A retrospective review of case notes was conducted over a 5-year period.
- Data from 105 pediatric patients (19 days to 13 years) were analyzed.
- Key variables included vital signs, rash characteristics, demographics, and patient outcomes.
Main Results:
- Fever (89.5%), tachypnea (73.3%), and rash (59%) were the most frequent presenting symptoms.
- Purpura and reduced systolic blood pressure were significantly associated with increased mortality.
- The incidence in Aboriginal children was approximately six times higher than in non-Aboriginal children; 17.1% of cases were initially misdiagnosed, predominantly in children under 2 years.
Conclusions:
- Meningococcal infection in children is characterized by fever and rash, with specific signs like purpura predicting poor outcomes.
- Significant demographic disparities exist, with higher incidence in Aboriginal populations and a male preponderance in neonates.
- Timely diagnosis is critical, as initial misdiagnosis, particularly in young children, can lead to adverse outcomes.
Objectives:
To review signs and symptoms in children diagnosed with meningococcal infection; to assess age, sex and race distribution of meningococcal infection; and to assess associations of the presenting features with morbidity and mortality.
Design:
Retrospective case notes review for a 5-year period.
Subjects:
105 patients aged between 19 days and 13 years. MAIN DATA REVIEWED: Temperature, blood pressure, heart rate, respiratory rate, type of rash, age, sex, race and outcome.
Results:
Of the 105 patients, 67.6% were Caucasian, 27.6% Aboriginal and 4.8% of other origin. There were 14.3% patients under 3 months of age (2.9% neonates), 48.6% between 3 months and 2 years, 21% between 2 and 4 years and 16.2% older than 4 years. The male:female ratio was 1.4. Features at presentation in decreasing order of frequency were: fever (89.5%), tachypnoea (73.3%), rash (59% [maculopapular 17.1%, petechial 27.6% and purpuric 14.3%]), vomiting (52.4%), irritability (44.8%), tachycardia (37.5%), lethargy (36.2%), neck stiffness (32.4%) and non-specific immediately preceding illness (15.2%). Purpura and a reduced systolic blood pressure were significantly associated with an increased risk of mortality, purpura and reduced diastolic blood pressure with an increased risk of morbidity. Initial misdiagnosis occurred in 17.1% of cases, with the majority of those misdiagnosed (83.3%) aged less than 2 years. Predominant serotyping was Group B followed by Group C. Major findings were a marked male preponderance in patients under 3 months of age. The incidence of meningococcal infection in the Aboriginal population was approximately six times that in the non-Aboriginal population. The yearly incidence of meningococcal disease during the study period ranged from 5.2 to 10.5 per 100,000. Long-term morbidity occurred in 8.6% of cases and mortality was 8.6%. Higher morbidity and mortality figures were found in those with septicaemia alone. Children referred from peripheral hospitals had a higher mortality but a comparable morbidity.