Prognostic Factors of Lewis in Acute Meningococcemia in Children

 

Patient population: Nigerian children during an epidemic of group A meningococcemia without meningitis and with ages ranging from 1.5 to 12 years

 

Coma	Shock	Mortality
absent	absent	6%
absent	present	22%
present	absent	38%
present	present	93%

 

where:

• Shock is defined as systolic blood pressure < 3rd percentile for an American population (< 85 mm Hg over 4 years of age, < 75 mm Hg under 4 years of age)

 

The outcome correlated with initial serum antigen titers.

(1) 57% of antigen positive cases died

(2) 100% of antigen negative cases survived

(3) 100% of patients with antigen < 0.25 µg/mL survived

(4) For children with antigen >= 0.25 µg/mL, 15 of 23 died (65%)

(5) The higher the titer, the more serious the disease.

 

Other observations:

(1) rectal temperature exceeding skin temperature by >= 3° C associated with mortality (reflects vasoconstricting shock)

(2) children with skin purpura had a higher mortality than those without

(3) length of history did not correlate with mortality

(4) deterioration characteristic: rate and depth of respiration increased, conscious level fell, purpura extended, central venous pressure fell to low or undetectable levels, heart rate rose to >= 150 beats/minute, with development of tetany and signs of pulmonary edema