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Fulminant meningococcal septicaemia. A hospital experience
Insights
An unusual surge in meningococcal septicaemia cases occurred in 1975, with high mortality. This bacterial infection presented with fever, prostration, and purpura, often leading to adrenal hemorrhage and gastrointestinal bleeds.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Meningococcal septicaemia (meningitis) is typically sporadic.
- A significant increase in cases was observed in early 1975.
Purpose of the Study:
- To report on an outbreak of meningococcal septicaemia in children.
- To describe the clinical and pathological features of these cases.
Main Methods:
- Case series analysis of 12 pediatric patients.
- Clinical data collection including symptoms, onset, and outcomes.
- Bacteriological confirmation (Neisseria meningitidis) from blood or cerebrospinal fluid.
- Necropsy findings in fatal cases.
Main Results:
- 12 cases of meningococcal septicaemia occurred in 5 months.
- High mortality rate: 8 of 12 patients died (3 on admission, 5 shortly after).
- Clinical presentation included fever, prostration, and abrupt onset of cutaneous purpura.
- Adrenal hemorrhage and upper gastrointestinal bleeds were noted in fatal cases.
Conclusions:
- The outbreak represented a significant deviation from the expected incidence of meningococcal septicaemia.
- The clinical and pathological findings highlight the severity of the disease.
- Further investigation into the cause of the outbreak and potential clustering is warranted.
Abstract:
In the first 5 months of 1975, 12 cases of meningococcal septicaemia were seen at a children's hospital where in previous years the condition was seen only sporadically. 3 of these children were dead on admission, 5 died shortly after admission, and 4 responded to treatment. Neisseria meningitidis was recovered from cerebrospinal fluid or blood or both in all cases, and the clinical illness was characterised by fever, prostration, and cutaneous purpura of abrupt onset. There were no significant previous illnesses, no recognisable prodromata, and, bacteriology apart, no pattern of laboratory results. There was a suggestion of centre-city clustering in the home background, although 2 of the patients came from rural areas. At necropsy gross adrenal haemorrhage was found in 6 of the 8 fatal cases, and upper gastrointestinal bleeds in the 5 deaths which were not sudden.