Meningococcal infection: clinical-evolutionary particularities

Abstract

Introduction. Meningococcal infection is an acute infectious disease caused by meningococcus, occurring with a variety of clinical manifestations - from asymptomatic carriage and nasopharyngitis to generalized forms (purulent meningitis, meningoencephalitis and meningococcemia with damage to various organs and systems).The incidence of endemic meningococcal disease ranges from 1 to 5 per 100,000 in developed countries, and from 10 to 25 per 100,000 in developing countries, with an increase in the number of cases in winter and spring, in temperate climates. Aim of study. To report the clinical data of meningococcal infection from Republic of Moldova, from June 2018 through April 2022. Methods and materials. The study is based on the analysis of the medical records of 21 children, of which 11 (52%) are male and 10 (48%) are female aged from 4 months to 11 years old, admitted to the Toma Ciorbă CHID during 2018- 2022. The diagnosis was confirmed by the following clinical and paraclinical methods: clinical signs, anamnestic data, bacteriological and bacterioscopic investigations. Results. Of the total number of patients meningococcemia occurred in 21 cases (100%),meningococcal meningitis in 19 cases (90,5%) and 18 pacients (85,7%) had both.The most common manifestations were fever (100%) and hemorrhagic rash (stellate, dotted) (100%), followed by meningeal signs(66,6%) along with hyperemic oropharynx(66,6%), vomiting(61,9%), harsh breathing(23,8), hemorrhagic rash with necrosis(23,8), diarrhea(19%), headache(19%), hypertrophied tonsils(19%) , injected conjunctiva(9,5%), photophobia(9,5), enanthema(9,5), paresis-paralysis(4,7%) and in the fulminant form - coma(4,7%).Consequences of meningococcemia that were found: infectious-toxic shock in 76,9 % of cases, cerebral edema in 23,8%, disseminated intravascular coagulation syndrome(DIC) in 9,5%, pulmonary edema in 4,7%, posteruptive necrosis 4,7%, toxic nephropathy 4,7%.Another type of meningococcal infection, less common,meningococcal arthritis occurred in 5 cases(23,8%) of experimental / studied patients. From the study group, one case associated with DIC,acute respiratory failure, pulmonary edema, toxic nephropathy and systemic inflammatory response syndrome resulted in death. Conclusion. Among the two most common forms of meningococcal infection: meningitis and meningococcemia, the second one was the most prevalent in the Republic of Moldova, with corresponding complications. occurring with a variety of clinical manifestations - from asymptomatic carriage and nasopharyngitis to generalized forms (purulent meningitis, meningoencephalitis and meningococcemia with damage to various organs and systems).The incidence of endemic meningococcal disease ranges from 1 to 5 per 100,000 in developed co untries, and from 10 to 25 per 100,000 in developing countries, with an increase in the num ber of cases in winter and spring, in temperate climates. Aim of study. To report the clinical data of meningococcal infection fro m Republic of Moldova, from June 2018 through April 2022. Methods and materials. The study is based on the analysis of the medical recor ds of 21 children, of which 11 (52%) are male and 10 (48%) are female aged from 4 mo nths to 11 years old, admitted to the Toma Ciorbă CHID during 2018- 2022. The diagnosis was confir med by the following clinical and paraclinical methods: clinical signs, anamnestic data, bacteriological and bacterioscopic investigations. Results. Of the total number of patients meningococcemia occurred in 21 cases (100%),meningococcal meningitis in 19 cases (90,5%) and 18 pacients ( 85,7%) had both.The most common manifestations were fever (100%) and hemorrhagic ras h (stellate, dotted) (100%), followed by meningeal signs(66,6%) along with hyperemic oropharynx( 66,6%), vomiting(61,9%), harsh breathing(23,8), hemorrhagic rash with necrosis(23,8), diarrhea(19%), headache(19%), hypertrophied tonsils(19%), injected conjunctiva(9,5%), photophobia( 9,5), enanthema(9,5), paresis-paralysis(4,7%) and in the fulminant form - coma(4, 7%).Consequences of meningococcemia that were found: infectious-toxic shock in 76,9 % of cases, cerebral edema in 23,8%, disseminated intravascular coagulation syndrome(DIC) in 9,5%, pulmonary edema in 4,7%, posteruptive necrosis 4,7%, toxic nephropathy 4,7%.Anoth er type of meningococcal infection, less common,meningococcal arthritis occurred in 5 cases(23,8%) of experimental / studied patients. From the study group, one case associated with DIC,acute respiratory failure, pulmonary edema, toxic nephropathy and systemic inflammatory re sponse syndrome resulted in death. Conclusion. Among the two most common forms of meningococcal infecti on: meningitis and meningococcemia, the second one was the most prevalent in the Republic of Moldova, with corresponding complications.