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
