Invasive meningococcal infection in Western Australia

Objectives: To review signs and symptoms in children diagnosed with meningo coccal infection: to assess age, sex and race distribution of meningococcal infection, and to assess associations of the presenting features with morb idity and mortality, Design: Retrospective case notes review for a 5-year period. Subjects: 105 patients aged between 19 days and 13 years. Main data reviewed: Temperature, blood pressure, heart rate, respiratory ra te, type of rash, age, sex, race and outcome. Results: Of the 105 patients, 67.6% were Caucasian, 27.6% aboriginal and 4. 8% of other origin. There were 14.3% patients under 3 months of age (2.9% n eonates), 48.6% between 3 months and 2 years, 21% between 2 and 4 years and 16.2% older than 4 years, The male:female ratio was 1.4. Features at prese ntation in decreasing order of frequency were: fever (89.5%), tachypnoea (7 3.3%), rash (59% [maculopapular 17.1%, petechial 27.6% and purpuric 14.3%]) , vomiting (52.4%), irritability (44.8%), tachycardia (37.5%), lethargy (36 .2%), neck stiffness (32.4%) and non-specific immediately preceding illness (15.2%). Purpura and a reduced systolic blood pressure were significantly associated with an increased risk of mortality, purpura and reduced diastol ic blood pressure with an increased risk of morbidity, Initial misdiagnosis occurred in 17.1% of cases, with the majority of those misdiagnosed (83.3% ) aged less than 2 years. Predominant serotyping was Group B followed by Gr oup C. Major findings were a marked male preponderance in patients under 3 months of age, The incidence of meningococcal infection in the Aboriginal p opulation was approximately six times that in the non-Aboriginal population . The yearly incidence of meningococcal disease during the study period ran ged from 5.2 to 10,5 per 100.000. Long-term morbidity occurred in 8.6% of c ases and mortality was 8.6%. Higher morbidity and mortality figures were fo und in those with septicaemia alone. Children referred from peripheral hosp itals had a higher mortality but a comparable morbidity.