Invasive Meningococcal disease, cerebrospinal fluid pleocytosis and acute adverse outcome of children in Tehran, Iran between 1991-2000

Abstract

The absence of cerebrospinal fluid (CSF) pleocytosis in invasive meningococcal disease (IMD) has been associated with an increased risk of death. It is unknown whether patients who lack a cellular response to central nervous system (CNS) infection are at the same risk of adverse outcome as patiens without CNS infection. To determine the frequency of presentation and outcome of three groups of children with IMD, Group 1, children with CSF pleocytosis (cells ≥ 10 mm3) and negative or positive cultures, Group 2, children without CSF pleocytosis and with negative CSF pleocytosis but with positive CSF cultures (CNS infection without CSF pleocytosis), we reviewed the medical records of children with IMD. Clinical and laboratory indies and severe adverse outcomes (definded as death or limb loss due to gangrene) were compared in three groups. Multivariable bogistic regression analysis was performed.Of the 108 available patients, 75 (69%) had CSF pleocytosis, 24 (23%) had bacteremia alone and 18 (16/7%) had CNS infection without CNS plocylosis. Patients with CNS infection without CSF pleocytosis had significantly lower white blood cell and platelet counts and more coagulopathy than patients with bacteremia (P<0.05) of patients with CSF bleocytosis (P<0.01). The frequency of adverse outcome was 61% for patients with CNS infection without CSF pleocytosis compared with 41.6% for patients with bacteremia alone (P<0.001) and (26.4%) for patients with CSF pleocytosis was independently associated with adverse outcome by multivariable logistic regression analysis (P<0.03). Approximately 38.5% of all children with IMD presented without CSF pleocytosis. Of these patients those with CNS infection without CSF pleacytosis were at higher risk of adverse outcomes than either patients with CSF pleocytosis or patients with bacteremia alone.