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Patient and strain characteristics in relation to the outcome of meningococcal disease: a multivariate analysis
R J Scholten1, H A Bijlmer, H A Valkenburg
1Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Abstract:
To investigate the joint association of patient and strain characteristics with the outcome of meningococcal disease (MD), data were collected on 563 consecutive cases of MD reported between 1989 and 1990 in The Netherlands. The meningococcal isolates were characterized with regard to their surface characteristics. Sequelae occurred in 8.5% of the patients, and were only associated with the presence of bacteraemia. The case-fatality rate was 7.7%. Infants aged < or = 5 months and patients in the age-groups of 10-19 years and > or = 50 years had an increased risk for a fatal outcome compared with children from 6 months to 9 years old (Odds Ratios [ORs]: 5.1, 3.4 and 9.8, respectively). The OR for females versus males was 2.3. The ORs for patients with bacteraemia, or a combination of bacteraemia and meningitis, compared with meningitic patients, were 2.3 and 3.1. Meningococcal strain characteristics did not influence the case-fatality rate substantially. In conclusion, host factors were found to be determinants for a fatal outcome of MD in The Netherlands from 1989 to 1990.
Insights
Host factors significantly impact meningococcal disease (MD) outcomes. Patient age, sex, and specific clinical presentations like bacteremia are key determinants of fatality, not bacterial strain characteristics.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Meningococcal disease (MD) remains a significant public health concern.
- Understanding factors influencing MD outcomes is crucial for effective management.
Purpose of the Study:
- To examine the combined influence of patient and bacterial strain characteristics on meningococcal disease outcomes.
- To identify risk factors associated with sequelae and case-fatality in MD patients.
Main Methods:
- Retrospective analysis of 563 consecutive MD cases in The Netherlands (1989-1990).
- Characterization of meningococcal isolates for surface features.
- Statistical analysis to determine associations between patient demographics, clinical presentation, bacterial factors, and outcomes (sequelae, fatality).
Main Results:
- The overall case-fatality rate was 7.7%, with sequelae in 8.5% of patients.
- Bacteraemia was associated with sequelae.
- Increased fatality risk observed in infants (<5 months), adolescents (10-19 years), and older adults (>50 years).
- Females had a higher fatality risk (OR=2.3).
- Bacteraemia and combined bacteraemia/meningitis increased fatality risk compared to meningitis alone.
- Meningococcal strain characteristics showed minimal impact on case-fatality.
Conclusions:
- Host factors, including age, sex, and clinical presentation (bacteraemia), are primary determinants of meningococcal disease fatality.
- Bacterial strain characteristics do not substantially influence the case-fatality rate.
- These findings underscore the importance of host-related factors in meningococcal disease prognosis.