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Mortality in meningococcal infections
Abstract:
Among 124 patients with meningococcal infections between 1966-1976, 108 had meningitis with a fatality rate of 7.4%, and 16 septicaemia with 18.8% fatality. High risk patients (more than 3 prognostically unfavourable characteristics) increased from 3.5% 1966-1970 to 15.6% 1971-1976, and the total mortality from 3.6 to 10.4%. The most unfavourable prognostic factor was low blood pressure at admission. High risk patients were more common among those who had meningococci with complete or partial sulfonamide resistance (25.7%) than among those having sensitive meningococci (11.9%). When the meningococci were at least partially sulfonamide-resistant, initial therapy with the combination of benzylpenicillin, sulfaisodimidine and chloramphenicol seemed to be more successful than benzylpenicillin alone in patients above 10 years. Ampicillin was used only in children, and these all survived.
Insights
Meningococcal infections saw increased high-risk patients and mortality over time. Sulfonamide-resistant bacteria correlated with higher risk, suggesting combination therapy improved outcomes in older patients.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Meningococcal infections, including meningitis and septicemia, present significant mortality risks.
- Treatment strategies and patient risk factors for meningococcal disease evolved between 1966 and 1976.
Purpose of the Study:
- To analyze trends in meningococcal infections, patient risk factors, and treatment outcomes over a decade.
- To evaluate the impact of sulfonamide resistance on disease severity and therapeutic efficacy.
Main Methods:
- Retrospective analysis of 124 patients diagnosed with meningococcal infections from 1966-1976.
- Categorization of patients based on prognostically unfavorable characteristics and bacterial sulfonamide resistance.
- Comparison of treatment regimens, including benzylpenicillin monotherapy versus combination therapy (benzylpenicillin, sulfaisodimidine, chloramphenicol) and ampicillin.
Main Results:
- Meningitis fatality rate was 7.4%, and septicemia fatality rate was 18.8%.
- High-risk patients increased from 3.5% to 15.6%, with total mortality rising from 3.6% to 10.4%.
- Low blood pressure was the most unfavorable prognostic factor. Sulfonamide-resistant meningococci were associated with a higher prevalence of high-risk patients (25.7% vs. 11.9%). Combination therapy showed better outcomes than benzylpenicillin alone in patients over 10 years with resistant strains.
Conclusions:
- Meningococcal disease epidemiology and patient risk profiles shifted during the study period.
- Sulfonamide resistance in meningococci poses a significant challenge, increasing disease severity.
- Combination antibiotic therapy demonstrated potential benefits over monotherapy for specific patient groups with sulfonamide-resistant meningococcal infections.