Clinical phenotypes and household structure in pediatric invasive meningococcal disease: A retrospective cohort study.

Abstract

Background: Invasive meningococcal disease is a rapidly progressive infection with heterogeneous clinical presentations. Phenotype-related severity differences in critically ill children remain incompletely defined. We evaluated the association between clinical phenotypes, early disease severity, and outcomes in a pediatric intensive care unit cohort.

Methods: This retrospective study included 42 children admitted to a tertiary pediatric intensive care unit with invasive meningococcal disease between 2006 and 2020. Patients were classified as meningococcal sepsis without meningitis or meningococcal meningitis. Disease severity was assessed using the Pediatric Risk of Mortality III score. Demographic, clinical, microbiological, and selected household characteristics were analyzed.

Results: Twenty-three patients (54.8%) had meningococcal sepsis without meningitis and 19 patients (45.2%) had meningococcal meningitis. The overall mortality was 21.4%. The sepsis phenotype was associated with higher Pediatric Risk of Mortality III scores (median 20 vs. 11, p=0.007), higher lactate, lower platelet counts, more organ support, and higher mortality (34.8% vs. 5.3%, p=0.023). Extended family living was more frequent in the meningitis group (26.3% vs. 4.3%, p=0.043). Serogroup data were available in 40.5% of cases, with serogroup B predominating.

Conclusions: In this pediatric intensive care unit cohort, meningococcal sepsis without meningitis was associated with greater early severity and higher mortality than meningococcal meningitis. Household-structure findings should be considered exploratory. Early phenotype-based risk assessment may support the management of critically ill children with invasive meningococcal disease.