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Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England
Helen Campbell1, Nick Andrews2, Sydel Parikh1
1Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Background:
Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014.
Methods:
Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death.
Results:
In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15-24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5-14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified.
Conclusions:
Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.
Insights
Invasive meningococcal disease (IMD) presentations vary by meningococcal group and age. Healthcare providers should recognize atypical symptoms in different age groups to improve diagnosis and outcomes.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Invasive meningococcal disease (IMD) commonly presents as meningitis or septicaemia.
- Atypical clinical presentations of IMD are rare but documented.
- Understanding these variations is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the relationship between meningococcal capsular groups (MenB, MenW, MenY), patient age, and clinical presentation in England.
- To analyze diagnostic patterns and outcomes of IMD cases in 2014.
- To identify associations between specific meningococcal groups, age, and clinical manifestations.
Main Methods:
- Utilized enhanced national surveillance data for laboratory-confirmed IMD cases (MenB, MenW, MenY) in individuals aged 5 years and older in England (2014).
- Classified presenting symptoms, diagnoses, and outcomes.
- Employed multivariable logistic regression to assess independent associations between capsular group, clinical presentation, gender, age, and mortality.
Main Results:
- In 2014, 340 IMD cases were recorded: MenB (179), MenW (95), MenY (66).
- Meningitis was more common in MenB cases and 15-24 year-olds; bacteraemic pneumonia was prevalent in MenY cases and ≥65 year-olds.
- Gastrointestinal and upper respiratory tract symptoms were noted in a significant proportion of cases, varying by capsular group and age; increasing age correlated with bacteraemic pneumonia.
Conclusions:
- Atypical clinical presentations of IMD are associated with specific meningococcal capsular groups and age demographics.
- Healthcare professionals must be aware of these variations to effectively diagnose and manage IMD.
- Enhanced awareness of atypical presentations across different age groups and serogroups can improve patient outcomes.
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