Robinson Joan L, Fanella Sergio, Lopez Alison, Frankel Craig, McDonald Jane, Alghounaim Mohammad, Slinger Robert, Bowes Jennifer, Khan Sarah, Comeau Jeannette L, Leifso Kirk, Gunawan John, Barton Michelle
Department of Pediatrics, University of Alberta, Edmonton, AB.
Department of Pediatrics, University of Manitoba, Winnipeg, MB.
Can Commun Dis Rep. 2020 Oct 1;46(10):339-343. doi: 10.14745/ccdr.v46i10a05.
Immunizations have led to a decrease in the incidence of invasive meningococcal disease (IMD) in Canada, but this infection still leads to significant morbidity and mortality.
The purpose of this study was to determine the burden of illness and management of IMD in paediatric hospitals.
Data were collected on all cases of IMD in eight paediatric hospitals from 2013 to 2017.
There were 17 cases of IMD. Three of eight hospitals had no cases. Just over half of the cases were serogroup B (n=9); a quarter (n=4) were serogroup W; less than a quarter (n=3) were serogroup Y; and one was unknown. Two infected children were not started on antibiotics until day one and day five after the initial blood culture was collected, but had uneventful recoveries. Six cases required admission to intensive care units; two died. Six cases had probable or proven meningitis. Thrombocytopenia was documented in seven cases. All cases had elevated C-reactive protein levels. Seven children received more than seven days of antibiotics; of these seven, only two had complications that justified prolonged therapy (subdural empyema and septic knee). Six cases had a central line placed.
IMD is now rare in Canadian children, but about one-third of the cases in our study required treatment in the intensive care unit and two died. Clinicians appear to not always be aware that a five to seven-day course is adequate for uncomplicated cases of bacteremia or meningitis.
免疫接种已使加拿大侵袭性脑膜炎球菌病（IMD）的发病率有所下降，但这种感染仍会导致严重的发病和死亡。
本研究的目的是确定儿科医院中IMD的疾病负担及管理情况。
收集了2013年至2017年八家儿科医院所有IMD病例的数据。
共17例IMD病例。八家医院中有三家无病例。略超过一半的病例为B群（n = 9）；四分之一（n = 4）为W群；不到四分之一（n = 3）为Y群；一例血清群不明。两名感染儿童在采集初始血培养后的第一天和第五天才开始使用抗生素，但恢复过程顺利。六例需要入住重症监护病房；两例死亡。六例有疑似或确诊的脑膜炎。七例记录有血小板减少症。所有病例的C反应蛋白水平均升高。七名儿童接受抗生素治疗超过七天；在这七名儿童中，只有两例有并发症，需要延长治疗时间（硬膜下积脓和化脓性膝关节炎）。六例放置了中心静脉导管。
IMD在加拿大儿童中现已罕见，但我们研究中约三分之一的病例需要在重症监护病房接受治疗，两例死亡。临床医生似乎并不总是意识到，对于无并发症的菌血症或脑膜炎病例，五至七天的疗程就足够了。
