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Acute paediatrics
Immune complex associated complications in the subacute phase of meningococcal disease: incidence and literature review
  1. C A Goedvolk,
  2. I A von Rosenstiel,
  3. A P Bos
  1. Department of Pediatric Intensive Care, Academic Medical Center, University of Amsterdam, Emma Children’s Hospital/AMC, Amsterdam, Netherlands
  1. Correspondence to:
    Dr A P Bos, Emma Children’s Hospital/AMC, PICU G8ZW, PO Box 22700, 1100 DE Amsterdam, Netherlands;
    a.p.bos{at}amc.uva.nl

Abstract

Aim: To determine the incidence of immune complex associated complications (IAC) after severe meningococcal disease (SMD) in a group of Dutch children admitted to a paediatric intensive care unit (PICU).

Methods: Retrospective chart analysis and follow up of 130 survivors of SMD admitted to PICU. Signs of IAC, inflammatory parameters, and temperature profile were reviewed.

Results: Of 130 children with SMD, 20 (15.3%) showed one or more of the three manifestations of IAC: 18 (13.8%) developed arthritis (effusion, with or without erythema/arthralgia), 11 (8.4%) vasculitis, and five (3.8%) pleuritis. Eighteen of 20 (90%) patients with IAC had a secondary rise in temperature; in patients with no IAC this was 48 of 110 (43.6%). IAC was associated with leucocytosis in 82.3% versus 47.7% in patients without IAC, and with increased CRP in 86.6% versus 47.2% in patients without IAC. Leucocytes on admission were significantly lower in patients who would later develop IAC (mean 8.6 versus 13.8×109/l).

Conclusion: IAC is a common complication of SMD, mainly occurring 4–10 days after systemic disease. IAC presents clinically as arthritis or vasculitis, mostly accompanied by secondary fever and raised inflammatory parameters.

  • meningococcal disease
  • type 3 hypersensitivity
  • reactive arthritis
  • complications
  • CRP, C reactive protein
  • ESR, erythrocyte sedimentation rate
  • IAC, immune complex associated complications
  • PICU, paediatric intensive care unit
  • SMD, severe meningococcal disease

https://doi.org/10.1136/adc.88.10.927

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