Sequelae of Invasive Meningococcal Diseases in Association withthe Incidence of an Invasive Clone of Neisseria Meningitidis ET-15/37.

Overview

The authors compared the course and sequelae of invasive meningococcal diseases (IMD) in 226subjects from the western Bohemian region in 1982-1997. Group A (1982-1993) compriseda total of 138 patients. In group B (1994-1997, n = 88) in the severity of the disease a newinvasive clone Neisseria meningitidis C:2a:P1.2,P1.5,ET-15/37 participated in a significantway. In group A the disease had in 75% the manifestations of purulent meningitis, in 13%meningitis with sepsis and in 12% of sepsis. The authors recorded one death, and as regardssequelae, hearing was affected in one patient. In meningitis with sepsis in two instances scarsafter skin necroses persisted. From a total of 17 septic cases of the disease the authors recordedfive deaths caused by fulminant sepsis - Waterhouse-Fridrichsen’s (WF) syndrome. The totallethality was 4%, permanent sequelae were recorded in 2% patients. In group B the diseasetook the course of meningitis in 31%, meningitis with sepsis in 11% and sepsis in 58% of the patients. Perception deafness was recorded in one instance. Of 51 cases with a septic course(incl. 39 with shock) 16 deaths caused by the WF syndrome were recorded. In survivors theauthors observed in 12 patients scars of necroses, in 13 a tendency for vasospastic crises of thelower extremities, in 11 loss of hair, in one patient a body weight loss of 25 kg. The total mortalitywas 18%, incl.41% in sepsis with shock. Permanent sequelae were recorded in 15% patients.Twenty five patients (33%) needed intensive invasive treatment, the mean value of theAPACHE II score was 22. The severity of the condition after the patient’s admission wasanalysed by means of scoring systems (Niklasson APACHE II, NESI, Rotterdam score).

Key words:
invasive meningococcal disease - clinical course - sequelae - scoring system -Neisseria meningitidis C:2a:P1.2,P1.5 - invasive clone ET-15/37.