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Investigation for complement deficiency following meningococcal disease
S Hoare1, O El-Shazali, J E Clark
1Paediatric Infectious Diseases Unit, Newcastle General Hospital, Newcastle upon Tyne, UK. simon.hoare@dial.pipex.com
Insights
Routine screening for complement deficiencies after meningococcal disease (MCD) is unnecessary for most children, particularly those with B or C serogroup infections. However, individual patient history remains crucial for identifying potential immunological abnormalities.
Area of Science:
- Immunology
- Pediatrics
- Infectious Diseases
Background:
- The incidence of complement abnormalities in the UK is unknown.
- Paediatric textbooks suggest complement system testing after meningococcal disease (MCD).
Observation:
- 297 children diagnosed with MCD were screened for complement activity over four years.
- Most cases involved serogroups B or C.
Findings:
- One child with serogroup B meningococcal septicaemia was diagnosed with C2 deficiency.
- This child had prior indicators of immunological issues.
Implications:
- Routine screening post-MCD (serogroups B/C) is not recommended.
- Focus on individual patient history for prior infections or recurrent neisserial infections is vital for identifying potential complement deficiencies.
Background And Aims:
The incidence of complement abnormalities in the UK is not known. It is suggested in at least three major paediatric textbooks to test for abnormalities of the complement system following meningococcal disease (MCD).
Methods:
Over a four year period, surviving children with a diagnosis of MCD had complement activity assessed. A total of 297 children, aged 2 months to 16 years were screened.
Results:
All children except one had disease caused by B or C serogroups. One child, with group B meningococcal septicaemia (complicated by disseminated intravascular coagulation and who required ventilation and inotropic support) was complement deficient. C2 deficiency was subsequently diagnosed. She had other major pointers towards an immunological abnormality prior to her MCD.
Conclusion:
It is unnecessary to screen all children routinely following MCD if caused by group B or C infection. However, it is important to assess the previous health of the child and to investigate appropriately if there have been previous suspicious infections, abnormal course of infective illnesses, or if this is a repeated episode of neisserial infection.