Intensive care of severe and fulminant meningococcal disease in children

M.A. Heorhiiants, V.A. Korsunov

Abstract


Meningococcal disease describes infections caused by the bacterium Neisseria meningitidis (also termed meningococcus). Invasive meningococcal disease remains a rare infectious disease not only with high mortality, but also with important morbidity, and remains a leading cause of sepsis. The Ukrainian epidemiology of meningococcal disease and medical errors of prehospital and emergency treatment were analysed. The most common and effective meningococcal sepsis prognostic scales are evaluated. When meningococcal disease is suspected, treatment must be started immediately and should not be delayed while waiting for investigations. The advanced principles of intensive care for aggressive forms of meningococcal diseases in pediatric patients are observed in this article. Relevant principles of antibacterial therapy, use of fluid resuscitation, inotropes, sympathomimetics and vasodilatators were described in detail. The antibiotics of choice are usually third generation broad spectrum cephalosporins, e.g., cefotaxime or ceftriaxone. Benzylpenicillin and chloramphenicol are also effective. The standard targets of resuscitation were presented. A case report of advanced treatment for meningococcal septic shock in a child was showed. The following methods of intensive care, such as glucocorticoids, fluid and electrolyte disturbance correction, acid-base disorders correction, respiratory support, efferent therapy, skin wound prophylactic and treatment, were characterized in the article.

Keywords


fulminant meningococcal disease; intensive care; children

References


Hamborsky J. Centers for Disease Control and Prevention Epidemiology and Prevention of Vaccine Preventable Diseases 13th Edition / J. Hamborsky, Kroger A., C. Wolf . [et al]. // 2015. - 375 pp.

Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study. / M. Sadarangani, D. Scheifele, S. Halperin [et al.]. // Clin Infect Dis. – 2015. - Vol. 60(8). P. 27-35. doi: 10.1093/cid/civ028.

Analyz ystroyy bolezny detey, umershykh ot menynhokokkovoy ynfektsyy v Ukrayne v 2008 h. / C.Kramarev, R. Moyseenko, V. Pedan [y soavt.] // Klinichna imunolohiya. Alerholohiya. Infektolohiya. - 2009 - # 9(28). - C. 13-15.

Meningitis Research Foundation. / Meningococcal Meningitis and Septicaemia. Guidance Notes. Diagnosis and Treatment in General Practice. Updated in line with NICE Bacterial Meningitis and Meningococcal Septicaemia CG102, SIGN Meningococcal Disease Guideline 102, and NICE Feverish Illness in Children CG1602014. – BMA. - 2014.

Rogers M. // Textbook of Pediatric Intensive Care. 5-th ed. Williams and Wilkins. – 2008. – 1710 рр.

Avoidable Deficiencies in the Delivery of Health Care to Children With Meningococcal Disease / S.Nadel, J.Britto, R.Booy [et al.] // J. Accid. Emerg. Med. – 1998. – Vol. 15(5). – P. 298-303.

Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery / R.Booy, P.Habibi, S.Nadel [et al.] - Arch Dis Child. – 2001. – Vol. 85. – P.386-390.

Maoldomhnaigh C. Invasive meningococcal disease in children in Ireland, 2001–2011 / C.Maoldomhnaigh, R.Drew, P.Gavin  // Arch Dis Child. – 2016. – Vol. 101. – P.1125-1129.

Andrew J. Meningococcal Disease: Methods and Protocols / J.Andrew, M. Pollard, J. Maiden. Humana Press. – 2001. – 720 pp.

Prognostic markers of meningococcal disease in children: recent advances and future challenges Expert Rev. / M.Montero-Mart, D.Inwald, E.Carrol [et al.] // Anti Infect. Ther. – 2014. – Vol. 12(11). – P. 1357–1369.

Narushenyya hemodynamyky pry tyazhelыkh formakh menynhokokkovoy ynfektsyy u detey. M.Heorhyyants A., Y.Odynets Yu., D.Kukhar' [y soavt.] // Vrachebnaya praktyka. - 2000 - #1. – S. 16-19.

Life-threatening heart failure in meningococcal septic shock in children: non-invasive measurement of cardiac parameters is of important prognostic value. / H. of ten Have, W.Wiegman, A. van den Hoek [et al.] // Eur J Pediatr. - 2000. – Vol. 159. – P. 277-282.

Myocardial depressant effects of interleukin 6 in meningococcal sepsis are regulated by p38 mitogen-activated protein kinase. / P.Nazima, J. Eleftherohorinou, H.Wright [et al.] // Crit Care Med. – 2011. - Vol.39(7). - P.1692-711.

Nakaz MOZ Ukrayiny #737. Vid 12.10.2009. Protokol likuvannya meninhokoktsemiyi u ditey.

 Management of invasive meningococcal disease in children and young peaple. A national clinical guideline. SIGN. – 2008. - 44 pp.

Heorhiyants M. / Tyazhki formy meninhokokovoyi infektsiyi u ditey. // M. Heorhiyants [i spivavt.] – Kh.: Zoloti storinky, 2006. – 176 s.

Matveev V. / Эpydemyolohyya, klynyka, dyahnostyka, lechenye y profylaktyka menynhokokkovoy ynfektsyy u detey. Vozmozhnosty UZ-yssledovanyy pry vыyavlenyy kontynhenta, osobo uhrozhaemoho po razvytyyu molnyenosnoy menynhokoktsemyy. Uchebno-metodycheskoe posobye. // Matveev V.A., Khulup H.Ya. – Mynskyu: BelMAPO, 2007. – 48 s.

Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. 2007 update from the American College of Critical Care Medicine / J. Brierley // Crit. Care. Med. – 2009 – Vol.37 – P.666-688.

Nadel S. Treatment of Meningococcal Disease. Review article. / S. Nadel // J.of Adolescent Health. - 2016. – Vol. 59. – P. 21-28.

Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replace­ment fluid therapy. / K.Powell, L. Sugerman, A. Eskenazi [et al.] // J Pediatr. – 1990. – Vol.117. – Р. 515-522.

Heorhiyants M.A., Korsunov V.A. Septychnyy shok u ditey. Pryntsypy diahnostyky ta intensyvnoyi terapiyi. Navchal'nyy posibnyk. – Kharkiv. «Zoloti storinky». 2009. – 248 s.

Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. / J.Boyd, J.Forbes T.Nakada [et al.] // Crit Care Med. – 2011. – Vol. 39(2). – P. 259-265.

Maric P. Noninvasive Cardiac Output Monitors: A State-of the- Art. Review. / P. Maric // Journal of Cardiothoracic and Vascular Anesthesia. – 2012. Article in press.

Heorhiyants M.A. Aktual'ni ta dyskusiyni pytannya infuziynoyi terapiyi septychnoho shoku u ditey. / M.Heorhiyants A., V. Korsunov // Medytsyna neotlozhnыkh sostoyanyy. – 2014. - # 1 (56) - .S. 77-81.

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 / R.P. Dellinger [et al.] // Crit. Care Med. – 2013. – Vol. 41. – P.580-637.

Khilnani P. Recent advances in sepsis and septic shock / P. Khilnani , S.Deopujari, J.Carcillo // Indian J. of Ped. – 2008. – Vol. 8. – P.821-830.

Double-Blind Randomized Clinical Trial Comparing Dopamine and Epinephrine in Pediatric Fluid-Refractory Hypotensive Septic Shock / K. Ramaswamy, S.Sunit, J. Muralidharan [et al.] // Pediatric Critical Care Medicine. - 2016 – Vol. 17. – P. 502–512.

The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases. / N.Ninis, C. Phillips, L. Bailey [et al.] // BMJ. - 2005. – Vol. 330. – P.331-323.

Mok Q. The outcome of children admitted to intensive care with meningococcal septicaemia. / Q.Mok, W.Butt // Intens. Care Med. – 1996 - №3. – Р. 259-263.

Minimizing limb amputations in meningococcal sepsis by early microsurgical arteriolysis / W. Boeckx, L. Nanhekhan, G. Vos [et al.] - 2009. - J of Ped Surgery. – Vol. 44. - P.1625-1630.

Conservative surgical management of necrotic tissues following meningococcal sepsis: Case report of a child treated with hyperbaric oxygen. / I.Takas, S.Kvolik, D.Divkovic [et al.] //UHM. – 2010. - Vol. 37. – P. 95-99.

Fystal' Э.Ya. Klynycheskyy sluchay menynhokoktsemyy u rebenka, oslozhnyvshyysya obshyrnыm nekrozom kozhy. / Э. Fystal', V.Soloshenko, V.Nosenko // Zdorov'e rebenka. – 2014. - #1(52). - S.150-152.

Long E. A randomised controlled trial of plasma filtration in severe pediatric sepsis / E.Long , F.Shann, D.Buckley // Critical Care and Resuscitation. – 2013. - Vol 15. - P. 198-204




DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102318

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru