Markers of poor prognosis in meningococcal sepsis

Abstract

Background. Neisseria meningitidis (meningococcus) is a highly fatal disease worldwide, occurring in epidemic and sporadic cases. The virulence of invasive N. meningitidis is determined by several key factors, including surface adhesins (pili), a protective capsule, and endotoxin release (lipid A from lipooligosaccharides). Furthermore, the bacterium has evolved genetic adaptations, including horizontal gene transfer, antigenic variation, and molecular mimicry, which allow it to successfully colonize mucosal surfaces, invade the bloodstream, and evade the immune system. The acquisition of N. meningitidis typically occurs through exposure to respiratory droplets. Meningococcal infection can present in both localized (nasopharyngitis, carriage) and generalized forms (meningitis, meningococcal bloodstream infection, meningoencephalitis, and mixed forms). Atypical presentations also include: arthritis, myocarditis, iridocyclitis, and others. The clinical form of infection is a key determinant of the outcome, the spectrum of potential complications and long-term sequelae, accounting for approximately 20-30% of cases. The epidemiology of N. meningitidis is variable and unpredictable. Early clinical symptoms are nonspecific and can lead to misdiagnosis and, therefore, delayed optimal treatment.

Objective. To analyze clinical and laboratory data to identify the clinical features and markers of adverse events in meningococcal sepsis (meningococcemia).

Materials and methods. We analyzed the records of inpatients under 18 years of age treated for meningococcemia (meningococcal sepsis) at the Minsk City Children's Infectious Diseases Clinical Hospital from 2009 to 2024.

Results. The main clinical manifestations of meningococcal sepsis are febrile fever (98.1-100%) and rash (100%). Meningococcemia most often occurs in combination with nervous system damage and the development of meningitis/meningoencephalitis (53.2-69.3%). The development of Waterhouse-Friderichsen syndrome in meningococcal sepsis increases the risk of death by almost 9 times. Conclusion. Established markers of an unfavorable course of meningococcal sepsis include septic shock and Waterhouse-Friderichsen syndrome.