IMMUNECOMPLEX-ASSOCIATED
COMPLICATIONS AFTER SEVERE MENINGOCOCCAL DISEASE
von Rosenstiel IA,
Goedvolk CA
Department of Pediatric Intensive Care, Emma Children��s
Hospital, Academic Medical Center, Amsterdam, The Netherlands
Objective: Aim of this study was to determine the incidence,
course and outcome of immunecomplex-associated complications (IAC) after
severe meningococcal disease (SMD) in a group of children admitted to the
PICU.
Methods: Retrospective chart analysis and follow-up of 130
survivors of SMD (median age 3.7 years, mean PRISM 13.4, mean GMSPS 6.3)
admitted to PICU (January 1993-August 2000). Mean duration of follow-up was
2.2 years (range 0.5-7.3). Signs of IAC, temperature profile and long-term
outcome were reviewed.
Results: Out of 130 children with SMD 20 (15.3%) showed one or
more of the three manifestations of IAC: 18 (13.8%) developed arthritis
(effusion ��
erythema/arthralgia), 11 (8.4%) vasculitis and 5 (3.8%) pleuritis.
Pleuritis presented on day 6 �� 5.1(mean ��
sd), arthritis on day 7.1 �� 3 and vasculitis on day 9.8 ��
4.1. Affected joints included knee (50%), ankle (27.7%) and elbow (11%),
with polyarthritis in 33%. 18 of 20 (90%) patients with IAC had secondary
rise in temperature, in patients without IAC this was 48 of 110 (43.6%)
(p<0.001). IAC was significantly associated with leukocytosis and
elevated CRP. No correlation was found between the occurrence of IAC and
age, PRISM or GMSPS. Leukocytes on admission were significantly lower in
patients who would later develop IAC: 8.6 vs. 13.8 10E9/L. 3 of 20 patients
with IAC (15%) had persistent joint symptoms after 1.5-2.5 years,
presenting as arthralgia on exercise with negative orthopedic findings.
Conclusion: IAC is a common complication in the sub-acute phase
of SMD. Arthritis and vasculitis are often associated with secondary fever
and elevated inflammatory parameters. Although outcome is favourable
residual joint complaints can occur.