2009-2019 年智利 61 例侵袭性脑膜炎奈瑟菌病患儿出院时的后遗症。
Sequelae at Hospital Discharge in 61 Children With Invasive Meningococcal Disease, Chile, 2009-2019.
机构信息
From the Postgraduate Department, Doctorate in Health Science with Pediatrics Specialty, Universidad de Chile, Santiago, Chile.
Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
出版信息
Pediatr Infect Dis J. 2022 Aug 1;41(8):607-613. doi: 10.1097/INF.0000000000003560. Epub 2022 Jul 13.
BACKGROUND
Invasive meningococcal disease (IMD) is an unpredictable and severe infection caused by Neisseria meningitidis . Its case fatality rate could vary from 9.7% to 26% and up to 36% of survivors may experience long-term sequelae, representing a challenge for public health.
AIMED
To describe the sequelae at hospital discharge caused by IMD in children between years 2009-2019.
METHODS
Cross-sectional study performed in 2 pediatric hospitals. Patients with microbiologically confirmed diagnosis of IMD from 2009 to 2019 were included. Bivariate and logistic regression analysis were performed.
RESULTS
The records of 61 patients were reviewed and included. Sixty-seven percent were male, median age 9 months (interquartile range 4-27), 72% were admitted to intensive care unit. Thirty-seven (60.5%) had at least 1 sequela (75% and 37% in patients with or without meningitis, respectively). The most frequents sequelae were neurological 72%, hearing loss 32%, and osteoarticular 24%. Significant differences were found comparing patients with and without sequelae: drowsiness 67.6% versus 41.7% ( P = 0.04), irritability 67.6% versus 25% ( P = 0.01), meningeal signs 62.2% versus 29.2% ( P = 0.01). In logistic regression analysis, postdischarge follow-up had OR 21.25 (95% confidence intervals [CI]: 4.93-91.44), irritability had OR 8.53 (95% CI: 1.64-44.12), meningeal signs had OR 8.21 (95% CI: 0.71-94.05), invasive mechanical ventilation had OR 8.23 (95% CI: 0.78-85.95), meningitis plus meningococcemia OR 1.70 (95% CI: 0.18-15.67) to have sequelae, while children with meningococcemia and vomiting had a OR 0.04 (95% CI: 0.00-0.36) and OR 0.27 (95% CI: 0.03-2.14), respectively. N. meningitidis serogroup W (MenW) was isolated in 54.1% (33/61), and N. meningitidis serogroup B (MenB) in 31.1% (19/61) of cases. A significant difference was found in osteoarticular sequelae ( P = 0.05) between MenB and MenW. There was a decrease in cases after the meningococcal conjugate vaccine against serogroups A, C, W and Y was implemented (2015-2019).
CONCLUSIONS
IMD remains as a public health concern. A high rate of sequelae was found in pediatric patients in our series, even in the clinical manifestations other than meningitis. Neurological sequelae were the most prevalent. Multidisciplinary follow-up protocols to reduce long-term impact must be urgently established to assess all children with IMD.
背景
侵袭性脑膜炎球菌病（IMD）是由脑膜炎奈瑟菌引起的一种不可预测且严重的感染。其病死率可能在 9.7%至 26%之间，多达 36%的幸存者可能会出现长期后遗症，这对公共卫生构成了挑战。
目的
描述 2009 年至 2019 年期间儿科 IMD 患者出院时的后遗症。
方法
在 2 家儿童医院进行了横断面研究。纳入了 2009 年至 2019 年微生物确诊为 IMD 的患者。进行了双变量和逻辑回归分析。
结果
共回顾了 61 例患者的记录，并纳入了其中的 61 例。67%为男性，中位年龄 9 个月（四分位距 4-27），72%入住重症监护病房。37 例（60.5%）至少有 1 种后遗症（脑膜炎患者中有 75%，无脑膜炎患者中有 37%）。最常见的后遗症是神经系统 72%、听力损失 32%和骨关节 24%。有后遗症和无后遗症的患者之间存在显著差异：嗜睡 67.6%比 41.7%（P=0.04）、易激惹 67.6%比 25%（P=0.01）、脑膜刺激征 62.2%比 29.2%（P=0.01）。在逻辑回归分析中，出院后随访的比值比（OR）为 21.25（95%置信区间 [CI]：4.93-91.44），易激惹的 OR 为 8.53（95% CI：1.64-44.12），脑膜刺激征的 OR 为 8.21（95% CI：0.71-94.05），侵袭性机械通气的 OR 为 8.23（95% CI：0.78-85.95），脑膜炎合并脑膜炎球菌血症的 OR 为 1.70（95% CI：0.18-15.67），有后遗症，而患有脑膜炎球菌血症和呕吐的儿童的 OR 分别为 0.04（95% CI：0.00-0.36）和 0.27（95% CI：0.03-2.14）。分离出脑膜炎奈瑟菌血清群 W（MenW）54.1%（33/61），血清群 B（MenB）31.1%（19/61）。在骨关节后遗症方面（P=0.05），MenB 与 MenW 之间存在显著差异。自 A、C、W 和 Y 群脑膜炎球菌结合疫苗实施以来（2015-2019 年），病例数量有所减少。
结论
侵袭性脑膜炎球菌病仍然是一个公共卫生问题。我们的系列研究中发现儿科患者的后遗症发生率很高，即使在非脑膜炎的临床表现中也是如此。神经系统后遗症最为常见。必须紧急制定多学科随访方案，以降低长期影响，对所有 IMD 患儿进行评估。
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