Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England

Helen Campbell; Nicholas Andrews; Sydel Parikh; Sonia Ribeiro; Steve Gray; Jay Lucidarme; Mary Ramsay; Raymond Borrow; Shamez Ladhani

doi:10.1016/j.jinf.2019.11.001

Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England

Helen Campbell, Nicholas Andrews, Sydel Parikh, Sonia Ribeiro, Steve Gray, Jay Lucidarme, Mary Ramsay, Raymond Borrow, Shamez Ladhani^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

18 Citations (Scopus)

Abstract

Background: Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014.

Methods: Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death.

Results: In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15–24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5–14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified.

Conclusions: Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.

Original language	English
Pages (from-to)	182-189
Number of pages	8
Journal	Journal of Infection
Volume	80
Issue number	2
Early online date	9 Nov 2019
DOIs	https://doi.org/10.1016/j.jinf.2019.11.001
Publication status	E-pub ahead of print - 9 Nov 2019

Bibliographical note

Funding Information: We thank the surveillance team at Public Health England, London, UK, and the laboratory staff at the Meningococcal Reference Unit of Public Health England for assistance; and local health protection teams and general practitioners, particularly Kazim Beebeejaun, Rehana Shivji, Anthony Carr, Stephen Clark, and Aiswarya Lekshmi, for contributions to national surveillance. This publication made use of the Meningitis Research Foundation Meningococcus Genome Library ( http://www.meningitis.org/research/genome ) developed by Public Health England, the Wellcome Trust Sanger Institute and the University of Oxford as a collaboration. The project is part funded by Meningitis Research Foundation.

Open Access: No Open Access licence

Publisher Copyright:Crown Copyright © 2019 Published by Elsevier Ltd on behalf of The British Infection Association. All rights reserved.

Citation: Campbell, Helen, et al. "Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England." Journal of Infection 80.2 (2020): 182-189.

DOI: https://doi.org/10.1016/j.jinf.2019.11.001

Keywords

Atypical presentation
Gastrointestinal symptoms
Meningococcal disease
Meningococcal pneumonia
Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jinf.2019.11.001

Cite this

@article{276f11e415fc4fee8b0fed86d2e49b79,

title = "Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England",

abstract = "Background: Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. Methods: Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. Results: In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28\%) and among 15–24 year-olds (20\%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26\%) and among ≥65 year-olds (24\%). Gastrointestinal symptoms were recorded preceding or during presentation in 15\% (40/269) cases with available information, including 5\% (7/140) MenB, 17\% (8/47) MenY and 30\% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16\% (22/141) MenB, 23\% (11/47) MenY and 31\% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5–14 year-olds compared to 24\% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. Conclusions: Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.",

keywords = "Atypical presentation, Gastrointestinal symptoms, Meningococcal disease, Meningococcal pneumonia, Outcome",

author = "Helen Campbell and Nicholas Andrews and Sydel Parikh and Sonia Ribeiro and Steve Gray and Jay Lucidarme and Mary Ramsay and Raymond Borrow and Shamez Ladhani",

note = "Funding Information: We thank the surveillance team at Public Health England, London, UK, and the laboratory staff at the Meningococcal Reference Unit of Public Health England for assistance; and local health protection teams and general practitioners, particularly Kazim Beebeejaun, Rehana Shivji, Anthony Carr, Stephen Clark, and Aiswarya Lekshmi, for contributions to national surveillance. This publication made use of the Meningitis Research Foundation Meningococcus Genome Library ( http://www.meningitis.org/research/genome ) developed by Public Health England, the Wellcome Trust Sanger Institute and the University of Oxford as a collaboration. The project is part funded by Meningitis Research Foundation. Open Access: No Open Access licence Publisher Copyright:Crown Copyright {\textcopyright} 2019 Published by Elsevier Ltd on behalf of The British Infection Association. All rights reserved. Citation: Campbell, Helen, et al. {"}Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England.{"} Journal of Infection 80.2 (2020): 182-189. DOI: https://doi.org/10.1016/j.jinf.2019.11.001",

year = "2019",

month = nov,

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doi = "10.1016/j.jinf.2019.11.001",

language = "English",

volume = "80",

pages = "182--189",

journal = "Journal of Infection",

issn = "0163-4453",

publisher = "W.B. Saunders Ltd",

number = "2",

}

TY - JOUR

T1 - Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England

AU - Campbell, Helen

AU - Andrews, Nicholas

AU - Parikh, Sydel

AU - Ribeiro, Sonia

AU - Gray, Steve

AU - Lucidarme, Jay

AU - Ramsay, Mary

AU - Borrow, Raymond

AU - Ladhani, Shamez

N1 - Funding Information: We thank the surveillance team at Public Health England, London, UK, and the laboratory staff at the Meningococcal Reference Unit of Public Health England for assistance; and local health protection teams and general practitioners, particularly Kazim Beebeejaun, Rehana Shivji, Anthony Carr, Stephen Clark, and Aiswarya Lekshmi, for contributions to national surveillance. This publication made use of the Meningitis Research Foundation Meningococcus Genome Library ( http://www.meningitis.org/research/genome ) developed by Public Health England, the Wellcome Trust Sanger Institute and the University of Oxford as a collaboration. The project is part funded by Meningitis Research Foundation. Open Access: No Open Access licence Publisher Copyright:Crown Copyright © 2019 Published by Elsevier Ltd on behalf of The British Infection Association. All rights reserved. Citation: Campbell, Helen, et al. "Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England." Journal of Infection 80.2 (2020): 182-189. DOI: https://doi.org/10.1016/j.jinf.2019.11.001

PY - 2019/11/9

Y1 - 2019/11/9

N2 - Background: Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. Methods: Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. Results: In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15–24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5–14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. Conclusions: Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.

AB - Background: Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. Methods: Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. Results: In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15–24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5–14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. Conclusions: Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.

KW - Atypical presentation

KW - Gastrointestinal symptoms

KW - Meningococcal disease

KW - Meningococcal pneumonia

KW - Outcome

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JO - Journal of Infection

JF - Journal of Infection

IS - 2

ER -

Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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