Clinical features and complications of epidemic group A meningococcal disease in Sudanese children.

The clinical presentation and laboratory features in relation to short-term outcome in 118 prospectively studied Sudanese children who were admitted with meningococcal (MC) meningitis and/or septicaemia during the 1988 group A MC epidemic in Greater Khartoum are described. Their ages ranged from 25 days to 15 years (mean: 78 months) and 42% were less than 5 years old. The male:female ratio was 1.6:1. Forty (34%) came from one of the peri-urban shanty towns encircling Greater Khartoum. A history of MC immunization (A and C vaccine) was obtained in 22%, but only five children (4.8%) had the vaccine between 4 weeks and 1 year before their illness. The commonest symptoms on admission were vomiting, neck rigidity and diarrhoea. Convulsions were significantly more frequent in children under 5 years old (p = 0.0005). Fifty-six (47%) had evidence of malnutrition. In descending order, fever, neck stiffness and Kernig's sign were the most commonly observed signs, the latter two being significantly more often detected in children older than 1 year. Twenty-four patients 20%) had disturbed consciousness. The case fatality rate was 6.3% and this was significantly higher in those presenting with meningococcal septicaemia (p = 0.0006). Other significant associations with mortality were short duration (less than 1 day) of symptoms (p = 0.0006) and clinical shock detected on admission p = 0.003). Transient complications were infrequent and permanent neurological sequelae were confined to bilateral profound sensorineural hearing loss in three children (2.9%) and hemiplegia in two 1.9%.(ABSTRACT TRUNCATED AT 250 WORDS)