title: Invasive meningococcal infection: analysis of 110 cases from a tertiary care centre in North East India.
abstract: OBJECTIVE
  To report an outbreak of invasive meningococcal disease from Meghalaya, in the north east India, from January 2008 through June 2009.
  
  
  METHODS
  Retrospective review of case sheets was done. One hundred ten patients with invasive meningococcal disease were included for the study.
  
  
  RESULTS
  Of the total patients, 61.8 % were boys and 38.2 % were girls (boy to girl ratio = 1.62:1). The average age of presentation was 8.48 ± 5.09 y. Meningococcal meningitis was seen in 61.8 % of cases, meningococcemia in 20 % and 18.2 % had both. Fever was the most common manifestation (100 %) followed by meningeal signs (78.2 %), headache (56.4 %), vomiting (53.6 %), shock (38.2 %), low Glasgow coma scale (GCS) (25.5 %), purpura and rashes (23.6 %), seizures (9.1 %), abdominal symptoms (4.5 %), irritability and excessive crying (4.5 %) and bulging anterior fontanalle (23 %) in those below 18 mo of age. Raised intracranial pressure (ICP) was the most common complication (28.2 %) followed by coagulopathy (16.4 %), hepatopathy (10 %), herpes labialis (9.1 %), syndrome of inappropriate ADH secretion (SIADH) (8 %), pneumonia (7 %), arthritis (6 %), purpura fulminans, respiratory failure, sixth nerve palsy and diabetes insipidus in 4.5 % each, subdural empyema, optic neuritis, ARDS and ARF in 1.8 % each, cerebral salt wasting syndrome, third nerve palsy, cerebritis and hearing impairment in 0.9 % each. Culture was positive in 35.5 %. Patients were treated initially with ceftriaxone and dexamethasone but later on with chloramphenicol due to clinical drug resistance. Mortality was 6.4 %.
  
  
  CONCLUSIONS
  This is the first epidemic report of invasive meningococcal disease from the north east India. Chloramphenicol acts well in areas with penicillin or cephalosporin resistance. Mortality reduces significantly with early diagnosis and prompt intervention.
authors: Department of Pediatric Disciplines, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences NEIGRIHMS, Mawdiangdiang, Shillong, Meghalaya, India. rashnadass@gmail.com
authors: Rashna
authors: R
authors: Dass Hazarika
authors: Nayan Mani
authors: NM
authors: Deka
authors: A B
authors: AB
authors: Khyriem
authors: W V
authors: WV
authors: Lyngdoh
authors: Himesh
authors: H
authors: Barman
authors: Sourabh Gohain
authors: SG
authors: Duwarah
authors: Pankaj
authors: P
authors: Jain
authors: Dibakar
authors: D
authors: Borthakur
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002443:Ceftriaxone / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D057915:Drug Substitution; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008589:Meningococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D009345:Neisseria meningitidis / Q000187:drug effects / Q000302:isolation & purification; D010406:Penicillins / Q000008:administration & dosage; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D010406:Penicillins; D002701:Chloramphenicol; D002443:Ceftriaxone; D003907:Dexamethasone