Clinical and Laboratory Manifestations of Meningococcemia in Children

Lack of vaccination and modern health care facilities in many countries including Iran let meningococcemia to remain as a serious challenging disorder especially among children and in spite of improved diagnosis and earlier treatment its prognosis is still dismal. This study describes 68 cases (54.4% male) of proved meningococcemia hospitalized since 1992 up to the end of 2002 in Children Medical Center Hospital, Tehran, Iran. Infants of 6 to 12 month old were a major concern in number (14.7%) and severity of disease. 5.9% of the cases have had at least two hospitalization history for meningococcal septicemia and 19.1% of the patients had Systemic Lupus Erythematosus (SLE), nephrotic syndrome or chronic liver disease in their past medical history. Meningeal irritation signs were seen in 55.9% and cerebrospinal fluid (CSF) smear was positive in 71.4% and culture was positive in 48.5% of patients. Meningococcal septicemia ended in shock (38.2%), Disseminated intravascular coagulation (DIC) (7.4%), thrombocytopenia (10.3%), arthritis (4.4%),ocular complications (2.9%), pericarditis (2.9%) and seizure (8.8%) in 51 of the cases, and death occurred in 7 patients. This study shows that the manifestation of the disease is similar to those described elsewhere except for lower pneumonia and no seasonal variations.