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Systemic meningococcal disease: the diagnosis on admission to hospital
F Borchsenius1, J N Bruun, T Tønjum
1Dept. of Infectious Diseases, Ullevål University Hospital, Oslo.
Abstract:
The clinical and laboratory findings in 176 patients hospitalized with suspected systemic meningococcal disease (MCd) are presented. All except nine patients were prospectively included in the MenOPP study. One hundred and fifteen patients were most likely to have meningococcal disease, of these 71 were confirmed with growth of meningococci in blood and/or cerebrospinal fluid (CSF). The remaining sixty-one patients served as the control group. Both petechiae, reduced general condition, and reduced consciousness proved valuable in the diagnosis of MCd. Petechiae was the clinical sign best discriminating between MCd and the control group. Ecchymoses were specific for meningococcal disease. Among the laboratory tests C-reactive protein (CRP) and Thrombotest (TT) were the tests which most frequently were found to be abnormal in patients with meningococcal disease. A diagnostic score is computed by the aid of a multiple regression analysis. This score includes the variables skin hemorrhages, body pain, CSF cell count, TT, CRP and white blood cell count. For a patient hospitalized with suspected MCd a score of three or more supports the diagnosis and should indicate the need for rapid antibiotic therapy.
Insights
Diagnosing meningococcal disease (MCd) relies on clinical signs like petechiae and laboratory markers such as C-reactive protein (CRP). A new diagnostic score aids in rapid antibiotic therapy decisions for suspected MCd cases.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Microbiology
Background:
- Systemic meningococcal disease (MCd) is a serious infection requiring prompt diagnosis.
- Clinical and laboratory findings are crucial for differentiating MCd from other conditions.
Purpose of the Study:
- To evaluate the diagnostic value of clinical and laboratory findings in suspected MCd.
- To develop a diagnostic score for MCd to guide timely treatment.
Main Methods:
- Prospective study of 176 hospitalized patients with suspected MCd.
- Analysis of clinical signs (petechiae, consciousness) and laboratory tests (CRP, Thrombotest).
- Development of a diagnostic score using multiple regression analysis.
Main Results:
- Petechiae and reduced consciousness were key clinical indicators.
- Ecchymoses were specific to meningococcal disease.
- Elevated C-reactive protein (CRP) and abnormal Thrombotest (TT) were frequent laboratory findings.
- A diagnostic score incorporating skin hemorrhages, pain, CSF cell count, TT, CRP, and WBC count was developed.
Conclusions:
- The diagnostic score effectively supports MCd diagnosis.
- A score of three or more indicates the need for rapid antibiotic administration.
- Clinical signs and laboratory markers are vital for managing suspected MCd.