Publication: 2003-2007 yılları arasında invazif meningokok enfeksiyonu olan çocukların değerlendirilmesi
Abstract
Amaç: Kliniğimizde invazif meningokok enfeksiyonu sebebiyle yatırılarak tedavi edilen olguların değerlendirilmesi amaçlanmıştır. Hastalar ve Yöntem: 2003-2007 yılları arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi Çocuk İntaniye Servisi’ne invazif meningokok enfeksiyonu sebebiyle yatırılan 16 olgunun geriye dönük olarak klinik, dermografik ve laboratuvar bulguları değerlendirilmiştir. Bulgular: 2003-2007 yılları arasında yatırılan toplam 16 (8 kız, 8 erkek) invazif meningokok enfeksiyonlu çocuğun (%56.25 meningokoksemi, %31.25 meningokoksemi ile menenjit ve %12.5 menenjit) yaşları ortalama 22.93±21.42 ay, yatış süresi 9.83±8.62 gün, mortalite oranı % 43.75 idi. Kan ve BOS kültürlerinden, sırasıyla, %56.25 ve %12.5 oranında Neisseria meningitidis izole edildi. %25 olguda lezyon kenarından yapılan sürüntüde Gram(-) diplokoklar izlendi. Sağkalıma etki eden faktörler olarak; ateş başlangıcı ile hastaneye başvuru arasında geçen süre, döküntü başlangıcı ile hastaneye başvuru arasında geçen süre, lökosit sayısı, serum AST ve CRP değerleri, solunum destek tedavisi uygulanması anlamlı bulundu. Olgular tanılarına göre gruplandı ve gruplar prognostik faktörler açısından karşılaştırıldı. Meningokoksemi ile meningokoksemi (+) menenjit grubunun kıyaslanmasında; yaş, ateş başlangıcı ile hastaneye başvuru arasında geçen süre, serum AST değerleri ve lökosit sayısı açısından anlamlı fark (p<0.05) bulundu. Meningokoksemi ile meningokoksemi (-) menenjit grubu karşılaştırıldığında; yaş, yatış süresi, ateş başlangıcı ile hastaneye başvuru arasında geçen süre, serum CRP seviyesi, beyin-omurilik sıvısında mm3’teki hücre sayısı ve protein seviyesi açılarından anlamlı fark (p<0.05) izlendi. Meningokoksemi (+) menenjit grubu ile meningokoksemi (-) menenjit grubu karşılaştırıldığında; beyin-omurilik sıvısında mm3’teki hücre sayısı ve tedavi süresi açılarından istatistiki anlamlı fark bulundu. Bir olgu Waterhouse- Friedrichsen Sendromu sebebiyle kaybedildi. Bir olguda Rotavirüs ishali, bir olguda yaygın purpura fulminans sonrasında ciltte Staphylococcus aureus’a bağlı cilt enfeksiyonu komplikasyon olarak gelişti. Tedavi olarak; olgulara antibiyoterapi, sıvı replasman ve şok tedavisi, uygun kan ve kan ürünü destek tedavisi, gerekli olgulara solunum ve dolaşım destek tedavisi uygulandı. Sonuç: İnvazif meningokok enfeksiyonları, halen önemli bir mortalite ve morbidite nedenidir. Ateş başlangıcı ile hastaneye başvuru arasında geçen süre, döküntü başlangıcı ile hastaneye başvuru arasında geçen süre, lökosit sayısı, serum AST ve CRP değerleri, solunum destek tedavisi uygulanması, sağkalıma etki eden faktörler olarak anlamlı bulunmuştur.
Aim: We aimed to evaluate the cases of invasive meningococcal disease hospitalized in our clinic. Materials and Methods: The dermographic, clinical and laboratory features of 16 patients with invasive meningococcal disease who were hospitalized in the Zeynep Kamil Maternity and Children&#8217; Hospital, Department of Pediatric Infectious Diseases between 2003-2007 were investigated retrospectively. Results: Of 16 children (8 girls, 8 boys) with invasive meningococcal disease, the exact diagnosis was: 56.25% meningococcemia, 31.25% meningococcemia (+) meningitis, 12.5% meningitis. The average age: 22.93±21.42 months, hospitalisation duration: 9.83±8.62 days, mortality rate: 43.75%. Neisseria meningitidis was isolated with a rate of 56.25% in blood and 12.5% in CSF cultures. In 25% of the cases, Gram (-) diplococci were observed on the Gram stain from the petechial skin lesions. Prognostic factors for survival were as follows: time between the onset of fever and admission to hospital, time between the onset of rash and admission to hospital, leucocyte count, serum AST and CRP levels, and presence of respiratory support treatment. The patients were separated according to their diagnosis and were compared with each other for prognostic factors: age, time between the onset of fever and admission to hospital, leucocyte count and serum AST levels were significantly different(p<0.05) between meningococcemia and meningococcemia(+) meningitis subgroups; age, hospitalization time, time between onset of fever and admission to hospital, serum CRP levels, the cell count and protein level/mm3 in CSF were significantly different (p<0.05) between meningococcemia and meningococcemia (-) meningitidis; the cell count/mm3 in CSF and hospitalisation duration were statistically different between meningitis with- and without meningococcemia subgroups. One patient died from Waterhouse- Friedrichsen Syndrome. Rotaviral diarrhea(n=1) and skin infection with Staphylococcus aureus following purpura fulminans (n=1) were observed as complications. Antibiotherapy, fluid replacement therapy, shock therapy, blood and blood products, respiratory and circulation support therapy (when necessary) were administered. Conclusion: Invasive meningococcal disease still has a high mortality and morbidity rate. Time between the onset of fever and admission to hospital, time between the onset of rash and admission to hospital, leucocyte count, serum AST and CRP levels, and the presence of respiratory support treatment were prognostic factors for survival.
Aim: We aimed to evaluate the cases of invasive meningococcal disease hospitalized in our clinic. Materials and Methods: The dermographic, clinical and laboratory features of 16 patients with invasive meningococcal disease who were hospitalized in the Zeynep Kamil Maternity and Children&#8217; Hospital, Department of Pediatric Infectious Diseases between 2003-2007 were investigated retrospectively. Results: Of 16 children (8 girls, 8 boys) with invasive meningococcal disease, the exact diagnosis was: 56.25% meningococcemia, 31.25% meningococcemia (+) meningitis, 12.5% meningitis. The average age: 22.93±21.42 months, hospitalisation duration: 9.83±8.62 days, mortality rate: 43.75%. Neisseria meningitidis was isolated with a rate of 56.25% in blood and 12.5% in CSF cultures. In 25% of the cases, Gram (-) diplococci were observed on the Gram stain from the petechial skin lesions. Prognostic factors for survival were as follows: time between the onset of fever and admission to hospital, time between the onset of rash and admission to hospital, leucocyte count, serum AST and CRP levels, and presence of respiratory support treatment. The patients were separated according to their diagnosis and were compared with each other for prognostic factors: age, time between the onset of fever and admission to hospital, leucocyte count and serum AST levels were significantly different(p<0.05) between meningococcemia and meningococcemia(+) meningitis subgroups; age, hospitalization time, time between onset of fever and admission to hospital, serum CRP levels, the cell count and protein level/mm3 in CSF were significantly different (p<0.05) between meningococcemia and meningococcemia (-) meningitidis; the cell count/mm3 in CSF and hospitalisation duration were statistically different between meningitis with- and without meningococcemia subgroups. One patient died from Waterhouse- Friedrichsen Syndrome. Rotaviral diarrhea(n=1) and skin infection with Staphylococcus aureus following purpura fulminans (n=1) were observed as complications. Antibiotherapy, fluid replacement therapy, shock therapy, blood and blood products, respiratory and circulation support therapy (when necessary) were administered. Conclusion: Invasive meningococcal disease still has a high mortality and morbidity rate. Time between the onset of fever and admission to hospital, time between the onset of rash and admission to hospital, leucocyte count, serum AST and CRP levels, and the presence of respiratory support treatment were prognostic factors for survival.