INFLAMMATORY PARAMETERS
AFTER SEVERE MENINGOCOCCAL DISEASE: WHAT DO THEY MEAN?
von Rosenstiel IA, Goedvolk CA
Department of Pediatric
Intensive Care, Emma Children¡¯s Hospital, Academic Medical Center,
Amsterdam, The Netherlands
Objective: To determine incidence, aetiology and significance of clinical and
elevated laboratory inflammatory parameters (IP) after severe meningococcal
disease (SMD).
Methods: Retrospective analysis of the records of 130 survivors of SMD
admitted to PICU (Jan 1993-Aug 2000). Clinical characteristics and
laboratory values were reviewed from day 5 onwards. Elevated IP were
defined as: secondary fever; a temperature of 38.5 ¡ãC after the patient has been afebrile for at least 24 hours;
leukocytosis ³20
10E9/L; CRP ³50
mg/L and ESR ³20
mm. Immune-complex Associated Complications (IAC) comprise reactive
arthritis, vasculitis and pleuritis.
Results: Median age was 3.7 years, mean PRISM 13.4 and mean GMSPS 6.3.
66/130 (50.3%) of the patients had secondary fever. 56/105 (53.3%) patients
had leukocytosis. Elevated CRP was found in 38/66 (57.7%) and elevated ESR
in 59/69 (85.5%). 87 (66.9%) patients had one or more elevated IP, despite
adequate treatment of infection. Identified causes according to place of
stay in the sub-acute phase (PICU or after transfer to the wards) are given
in table 1.
|
Aetiology of elevated IP ³
day 5
|
PICU
|
Wards
|
|
E.C.I.
|
46.9%
|
53.7%
|
|
Tissue necrosis
|
32.6%
|
28.4%
|
|
Secondary infection
|
16.3%
|
4.4%
|
|
IAC
|
16.3%
|
23.8%
|
Elevated IP were very sensitive for detecting IAC, secondary
infection and necrosis but not specific, with a low positive predictive
value.
Conclusion: Since there is a high incidence of elevated IP in the sub-acute
phase of SMD differential diagnosis is emphasized to avoid improper
management.