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Myocardial depression in septic shock caused by meningococcal infection
Abstract:
Comparative hemodynamic measurements recorded in 19 cases of septic shock associated with Neisseria meningitidis bacteremia and in 20 shock cases associated with bacteremia due to other Gram-negative bacilli showed a significantly higher incidence of early myocardial depression in the cases with meningococcal infection. Echocardiographic, ECG, and serum enzyme (CK-MB isoenzyme) studies closely correlated with impaired myocardial contractility and development of cardiogenic shock in patients with meningococcal bacteremia. Autopsy of the heart from three patients who succumbed to shock confirmed the presence of myocarditis with intracellular Gram-negative diplococci. Our observations suggest that the onset of cardiac dysfunction precedes clinical manifestations of shock.
Insights
Meningococcal infections cause early heart muscle depression and cardiogenic shock more often than other Gram-negative bacteria. This cardiac dysfunction can appear before clinical signs of shock in patients with meningococcal bacteremia.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Septic shock is a life-threatening condition often caused by Gram-negative bacteria.
- Meningococcal infections can lead to severe sepsis and shock.
- The cardiac impact of meningococcal septic shock requires further elucidation.
Purpose of the Study:
- To compare hemodynamic function in patients with septic shock due to Neisseria meningitidis versus other Gram-negative bacilli.
- To investigate the incidence and characteristics of myocardial depression in meningococcal bacteremia.
- To correlate cardiac dysfunction with clinical manifestations and pathological findings.
Main Methods:
- Comparative hemodynamic measurements in 19 meningococcal and 20 other Gram-negative bacilli septic shock cases.
- Echocardiographic, electrocardiographic (ECG), and serum enzyme (CK-MB isoenzyme) assessments.
- Autopsy examination of cardiac tissue in fatal cases.
Main Results:
- Significantly higher incidence of early myocardial depression in meningococcal infection cases.
- Impaired myocardial contractility and cardiogenic shock correlated with echocardiographic, ECG, and CK-MB findings.
- Autopsy revealed myocarditis with intracellular Gram-negative diplococci in fatal meningococcal cases.
Conclusions:
- Neisseria meningitidis bacteremia is associated with a higher risk of early myocardial depression compared to other Gram-negative bacilli.
- Cardiac dysfunction, including myocarditis, is a significant complication of meningococcal septic shock.
- Cardiac dysfunction may precede the clinical onset of shock in meningococcal infections.