IMMUNECOMPLEX-ASSOCIATED COMPLICATIONS AFTER SEVERE MENINGOCOCCAL DISEASE

von Rosenstiel IA, Goedvolk CA

Department of Pediatric Intensive Care, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands

Objective: Aim of this study was to determine the incidence, course and outcome of immunecomplex-associated complications (IAC) after severe meningococcal disease (SMD) in a group of children admitted to the PICU.

Methods: Retrospective chart analysis and follow-up of 130 survivors of SMD (median age 3.7 years, mean PRISM 13.4, mean GMSPS 6.3) admitted to PICU (January 1993-August 2000). Mean duration of follow-up was 2.2 years (range 0.5-7.3). Signs of IAC, temperature profile and long-term outcome were reviewed.

Results: Out of 130 children with SMD 20 (15.3%) showed one or more of the three manifestations of IAC: 18 (13.8%) developed arthritis (effusion ± erythema/arthralgia), 11 (8.4%) vasculitis and 5 (3.8%) pleuritis. Pleuritis presented on day 6 ± 5.1(mean ± sd), arthritis on day 7.1 ± 3 and vasculitis on day 9.8 ± 4.1. Affected joints included knee (50%), ankle (27.7%) and elbow (11%), with polyarthritis in 33%. 18 of 20 (90%) patients with IAC had secondary rise in temperature, in patients without IAC this was 48 of 110 (43.6%) (p<0.001). IAC was significantly associated with leukocytosis and elevated CRP. No correlation was found between the occurrence of IAC and age, PRISM or GMSPS. Leukocytes on admission were significantly lower in patients who would later develop IAC: 8.6 vs. 13.8 10E9/L. 3 of 20 patients with IAC (15%) had persistent joint symptoms after 1.5-2.5 years, presenting as arthralgia on exercise with negative orthopedic findings.

Conclusion: IAC is a common complication in the sub-acute phase of SMD. Arthritis and vasculitis are often associated with secondary fever and elevated inflammatory parameters. Although outcome is favourable residual joint complaints can occur.

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