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Invasive meningococcal infection in Western Australia
Author(s) -
Olesch CA,
Knight GJ
Publication year - 1999
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1046/j.1440-1754.1999.t01-1-00337.x
Subject(s) - medicine , petechial rash , lethargy , pediatrics , blood pressure , rash , mortality rate , surgery
Objectives: To review signs and symptoms in children diagnosed with meningococcal infection; to assess age, sex and race distribution of meningococcal infection; and to assess associations of the presenting features with morbidity and mortality. Design: Retrospective case notes review for a 5‐year period. Subjects: 105 patients aged between 19 days and 13 years. Main data reviewed: Temperature, blood pressure, heart rate, respiratory rate, type of rash, age, sex, race and outcome. Results: Of the 105 patients, 67.6% were Caucasian, 27.6% Aboriginal and 4.8% of other origin. There were 14.3% patients under 3 months of age (2.9% neonates), 48.6% between 3 months and 2 years, 21% between 2 and 4 years and 16.2% older than 4 years. The male:female ratio was 1.4. Features at presentation in decreasing order of frequency were: fever (89.5%), tachypnoea (73.3%), rash (59% [maculopapular 17.1%, petechial 27.6% and purpuric 14.3%]), vomiting (52.4%), irritability (44.8%), tachycardia (37.5%), lethargy (36.2%), neck stiffness (32.4%) and non‐specific immediately preceding illness (15.2%). Purpura and a reduced systolic blood pressure were significantly associated with an increased risk of mortality, purpura and reduced diastolic blood pressure with an increased risk of morbidity. Initial misdiagnosis occurred in 17.1% of cases, with the majority of those misdiagnosed (83.3%) aged less than 2 years. Predominant serotyping was Group B followed by Group C. Major findings were a marked male preponderance in patients under 3 months of age. The incidence of meningococcal infection in the Aboriginal population was approximately six times that in the non‐Aboriginal population. The yearly incidence of meningococcal disease during the study period ranged from 5.2 to 10.5 per 100.000. Long‐term morbidity occurred in 8.6% of cases and mortality was 8.6%. Higher morbidity and mortality figures were found in those with septicaemia alone. Children referred from peripheral hospitals had a higher mortality but a comparable morbidity.