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. 2023 Aug 1;42(8):660-666.
doi: 10.1097/INF.0000000000003965. Epub 2023 Jun 1.

Hypervirulent Strains of Neisseria meningitidis and Clinical Manifestations in Children With Invasive Meningococcal Disease

María Carolina Rivacoba  1 , Rodolfo Villena  1   2 , Juan Carlos Hormazabal  3 , Dona Benadof  2   4 , Ernesto Payá  1   2 , Francisca Valdivieso  5 , Andrea Canals  6   7 , Cindy Arteta-Acosta  2   5 , María Elena Santolaya  2   5
Affiliations

Hypervirulent Strains of Neisseria meningitidis and Clinical Manifestations in Children With Invasive Meningococcal Disease

María Carolina Rivacoba et al. Pediatr Infect Dis J. .

Abstract

Background: Hypervirulent clonal complex (cc) have been associated with higher incidence and case fatality rate of invasive meningococcal disease (IMD). The aim of this study was to describe the clinical manifestations of the hypervirulent cc of meningococcus in children.

Methods: Retrospective study in patients hospitalized by IMD microbiologically confirmed at three children's tertiary health care centers in Santiago, Chile, between 2010 and 2018. Demographic, clinical information and determination of the cc and factor H binding protein (fHbp) alleles were performed.

Results: In total 93 cases were evaluated, sequence typing was available for 91 cases, and 87 (95.6%) had a cc assigned; 63.7% were MenW and 31.8% MenB. The median age was 9 months, 67% were male and 18.7% had any comorbidity. A 26.4% presented neurological deficit, 25.3% petechiae and 20% diarrhea. Sixty-seven percent were admitted to the pediatric intensive care unit (PICU) and the case fatality rate was 9.9%. Regarding cc and fHbp alleles, ST11, ST41/44 and allele 22 were the most frequently identified, with 63.7%, 19.8% and 72.5%, respectively. We found statistically significant differences between the cc and presence of petechiae, diagnosis of meningococcemia plus meningitis, admission and days in PICU and advanced support. Allele 22 for fHbp was associated with the absence of petechiae, low suspicion of IMD, less diagnosis of meningitis+meningococcemia, PICU admission, advanced support and adrenal insufficiency.

Conclusion: Epidemiological and microbiological surveillance of IMD should integrate clinical and laboratory components, including molecular and genetic characterization, to enrich the dynamic understanding of the clinical evolution of IMD.

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Conflict of interest statement

R.V.: grants to support research projects from Janssen and consultancy fee from Pfizer, GSK and Sanofi Pasteur, outside the scope of the submitted work. J.C.H. and C.A-A: National Doctorate scholarship – ANID. D.B.: grants and consulting fees from Biomerieux and Fresenius Kabi, outside the scope of the submitted work. M.E.S.: grants to support research projects and consultancy fee from GSK, Pfizer, and Sanofi Pasteur, outside the scope of the submitted work. The other authors have no conflicts of interest to disclose.

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