1/118. risk factors for meningococcal disease in Cape Town.OBJECTIVE: To determine the risk factors associated with meningococcal disease among children living in Cape Town. DESIGN: A case-control study was conducted from October 1993 to January 1995. SETTING: The study population consisted of all children under the age of 14 years who were resident in the Cape Town metropolitan region. Cases and controls were selected from red cross war Memorial Children's Hospital. RESULTS: A total of 70 cases and 210 controls were interviewed. Significant risk factors for meningococcal disease included being breast-fed for less than 3 months (adjusted odds ratio (OR) 2.4); overcrowding (adjusted OR 2.3); and age less than 4 years (adjusted OR 2.3). Exposure to two or more household members who smoked was also a risk factor, but only in the presence of a recent upper respiratory tract infection (adjusted OR 5.0). CONCLUSION: This is the first case-control study in south africa examining risk factors for meningococcal disease. It provides further evidence for reduction of smoking, reduction of overcrowding and promotion of breast-feeding as important public health measures.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/118. Acute abdomen as an atypical presentation of meningococcal septicaemia.The clinical manifestations and course of meningococcal disease have been well described, but atypical presentations may, if unrecognized, lead to a delay in treatment. We describe here an unusual case of this disease in a 21-y-old woman who presented with an acute rigid abdomen, clinical and laboratory features of sepsis, shock and early DIC with no indication of meningococcal infection. She developed a rapidly spreading purpuric rash, conjunctival haemorrhages, hypotension and tachycardia and a low urine output. Laboratory investigations showed a low platelet count, low haemoglobin and normal WBC. A presumptive diagnosis of meningococcal septicaemia was made and recovery followed treatment with cefotaxime, fluids and inotropes. A fully sensitive Neisseria meningitis Group C, type 2a, subtype NT was isolated from blood cultures, but not from CSF obtained after antibiotic treatment.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
3/118. erythema nodosum secondary to meningococcal septicaemia.We report a case of erythema nodosum (EN) secondary to neisseria meningitidis infection in a 77-year-old woman. histology of two biopsy specimens from two different lesions showed characteristic features of EN. blood culture showed neisseria meningitidis group C.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
4/118. Meningococcal disease and meningitis: a review of deaths proceeding to coroner directed autopsy in Auckland.AIMS: To assist the early diagnosis of meningitis, by finding trends and patient profiles, where delay or other factors may have lead to a fatal outcome. methods: All deaths from meningitis and meningococcal disease, confirmed at autopsy were reviewed. The study involved the Auckland area, in the period January 1988 November 1997. RESULTS: Cases were divided into those caused by N meningitidis and other meningitides. death due to N meningitidis is often within 12-24 hours of the first symptomatology. Symptoms are often vague and may be indistinguishable from any other infection, often leading to fatal patient or doctor delay. A diagnosis of meningococcal disease cannot be excluded on: no rash (44%), no "meningitis" symptoms as sepsis without meningitis occurs (44%), age (50% were over 15 years old) or the presence of other abnormalities, eg bronchopneumonia or hydrocephalus. Non-N meningitidis menigitis is a disease of the very young or old, its time course is also swift with 30% suffering similar vague symptoms for less than 24 hours before death. CONCLUSIONS: For both categories, treat immediately and treat on suspicion, otherwise conformation of the diagnosis might be postmortem.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
5/118. Meningococcal disease in siblings caused by rifampicin sensitive and rifampicin resistant strains.Two brothers presented with meningococcal infection in a five day period, the first with a rifampicin sensitive strain and the second, who had received rifampicin chemoprophylaxis, with a resistant strain. Secondary cases of meningococcal disease can occur despite chemoprophylaxis, and may be rifampicin resistant. Close contacts should be informed of the early symptoms of meningococcal disease and of the need to seek medical advice urgently if they occur.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
6/118. Infection with uncommon subgroup Y neisseria meningitidis in patients with systemic lupus erythematosus.The association of neisseria meningitidis infection and systemic lupus erythematosus (SLE) is uncommon. We describe here three patients with SLE who developed disseminated meningococcal disease. Each patient had long-standing SLE and was receiving treatment with prednisone. Furthermore, each patient showed serum hypocomplementemia at the time of the infection. N. meningitidis Group Y, considered to be an organism of relatively low virulence, was isolated from the blood or cerebrospinal fluid in each case. The patients presented with diverse clinical manifestations of meningococcal disease. The relationship of disseminated meningococcal infections to hypocomplementemia in patients with SLE is discussed in light of a review of the literature.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
7/118. Non-Q wave acute myocardial infarction in acute meningococcemia in a 10-year-old girl.INTRODUCTION: Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. CASE: We present the case of a 10-year-old girl with positive family history for premature myocardial infarction who sustained an acute myocardial infarction temporally related to meningococcemia. DISCUSSION: This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin i levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
8/118. Generic polymerase chain reaction followed by dna sequencing as a means of diagnosing bacteraemia.There is increasing use of polymerase chain reaction techniques to diagnose infection. We report the use of polymerase chain reaction using a generic section of the bacterial 16S rDNA gene--followed by nucleotide sequencing--to determine the species of the infecting bacteria. In the first case, the clinical and microbiological diagnosis of meningococcal septicaemia was in agreement with the results from polymerase chain reaction technique. In the second case, a yersinia enterocolitica bacteremia was detected by the polymerase chain reaction technique, but missed with conventional blood culture techniques.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
9/118. Meningococcal conjunctivitis.Meningococcal conjunctivitis is typically described as an acute purulent infection. An atypical case of mild catarrhal conjunctivitis occurred in a 19-year-old college student. The meningococci were identified as neisseria meningitidis, group A, and were isolated from the throats of the patient and her roommate. The conjunctivitis responded rapidly to treatment with sodium sulfacetamide, and it was not treated systemically. A short review of the literature of meningococcal conjunctivitis is presented, and the current recommendation for prophylaxis is discussed.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/118. purpura fulminans in children: report of two cases.purpura fulminans, usually seen in previously healthy children acquiring severe infections, especially meningococcal sepsis and meningitis, is a rare catastrophic disease with initial hemorrhagic skin lesions rapidly progressing to gangrene accompanied by shock and frequently resulting in death. We report 2 cases of purpura fulminans who were diagnosed in the past 2 years. Both blood cultures yielded neisseria meningitidis. One of them expired within 48 hours after admission despite aggressive therapy. The second patient, who received the treatment of heparin, antibiotics, and blood product replacement, survived with minimal sequelae. We deem young age and severe coagulopathy are especially associated with a fatal outcome in children with purpura fulminans. Early recognition of this disease and prompt appropriate therapy may be lifesaving for these patients.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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