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. 2020 Feb;80(2):182-189.
doi: 10.1016/j.jinf.2019.11.001. Epub 2019 Nov 9.

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

Helen Campbell  1 , Nick Andrews  2 , Sydel Parikh  1 , Sonia Ribeiro  1 , Steve Gray  3 , Jay Lucidarme  3 , Mary E Ramsay  1 , Ray Borrow  3 , Shamez N Ladhani  4
Affiliations

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

Helen Campbell et al. J Infect. 2020 Feb.

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.

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Conflict of interest statement

Declaration of Competing Interest HC, NA, SP, SR and MER have no personal competing interests. PHE National Infection Service, Immunisation and Countermeasures Division has provided vaccine manufactures with post-marketing surveillance reports which the Marketing Authorisation Holders are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. SL performs contract work on behalf of St George’s university of London for GlaxoSmithKline, Pfizer, and Sanofi Pasteur. RB, JL and SJG perform contract research on behalf of Public Health England for GlaxoSmithKline, Pfizer, and Sanofi Pasteur. None of these authors receive personal remuneration.

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