Increasing microbiological confirmation and changing epidemiology of meningococcal disease on Merseyside, England.
OBJECTIVE
To determine, for the last 5 years in children on Merseyside with clinical meningococcal disease (MCD), the impact on diagnostic yield of newer bacteriologic methods; bacterial antigen detection (AD) and polymerase chain reaction (PCR).


METHODS
Prospective data collection at Royal Liverpool Children's Hospital over two epochs: 1 September 1992 to 30 April 1994 (epoch A, n = 126) and 17 November 1997 to 15 September 1998 (epoch B, n = 85).


RESULTS
Epoch A was compared with epoch B. Diagnosis was confirmed by detection of meningococci in 78 of 126 (61.9%) versus 64 of 85 (75.3%, P = 0.04), but with a significantly lower rate of positive blood and cerebrospinal fluid culture in the later epoch. The proportion of cases receiving penicillin pretreatment was unchanged at 32%, but the proportion undergoing lumbar puncture decreased significantly. Median ages were higher in epoch B: 1.7 years versus 2.49 years (P = 0.013, Mann-Whitney). There was a significant increase in the proportion of cases due to serogroup C (14/78 (18%) versus 30/64 (46.9%), P = 0.001).


CONCLUSIONS
Culture detection of meningococci from children with MCD has reduced, as less lumbar punctures are done. However, improved diagnosis by PCR and AD has increased microbiological confirmation overall. Serogroup C disease and the median age of cases continue to rise.
Carrol
E D
ED
Institute of Child Health, Royal Liverpool Children's NHS Trust, Liverpool, UK. edcarrol@liverpool.ac.uk
Thomson
A P
AP
Riordan
F A
FA
Fellick
J M
JM
Shears
P
P
Sills
J A
JA
Hart
C A
CA
D000293:Adolescent; D000372:Agglutination Tests; D000942:Antigens, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D009345:Neisseria meningitidis / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D000942:Antigens, Bacterial; D004269:DNA, Bacterial