Trends in Mortality in Children Hospitalized with Meningococcal Infections in Albania from 2006 to 2014

Gjovalin Valca, Ermira Kola, Alketa Qosja (Hoxha), Ilirjana Bakalli, Robert Lluka, Durim Shala, Inva Gjeta, Ermela Gjyzeli, Sashenka Sallabanda


Background: Lack of vaccination and modern health care facilities in many countries including Albania let meningococcemia to remain as a serious challenging disorder especially among children and in spite of improved diagnosis and earlier treatment its prognosis is still dismal. Patients expected to develop life-threatening complications in acute meningococcal infections require early recognition and appropriate monitoring. Different prognostic scoring systems have been developed. Aim: The aim of this study was to evaluate mortality in children hospitalized with meningococcal infections in Albania, including scoring systems in prognosticating mortality rate. Materials and Methods: This was a retrospective descriptive study, performed on 40 patients with definite diagnosis of meningococcal infection admitted to PICU in UHC “Mother Teresa”, Tirana, Albania, between 2006 and 2014. There were 40 patients, 22(55%) males, and 18(45%) females, from 2 months to 10 years old. We evaluated all the patients based on Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score. Data were collected by filling checklists. SSPS software was applied to analyze the data using chi-square test. Results: Overall mortality was 42%. According to the GMSPS(3) prognostic score of meningococcemia: 28 (70%) patients had a score <8 points and were recorded four deaths representing a mortality rate of 14.2%; the mortality rate of 12(45%) patients with a score ≥8 points resulted in 100% mortality. The sensitivity was 100%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 100% for a GMSPS score ≥8. According to the Stiehm and Damrosch criteria (2): 22(55%) patients had two or fewer factors present and was recorded three deaths representing a mortality rate of 13.6%; the mortality rate of 18(45%) patients with three or more factors present the mortality rate was 72.2%. The sensitivity was 90%, specificity was 80%, the positive predictive value was 75% and negative predictive value was 92.3% for the criterion ≥3 of the Stiehm and Damrosch criteria. Conclusions: Meningococci are still killers, they affect men more than women. The Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score can rapidly identify children with the fulminant meningococcal disease and poor prognosis and help us starting prompt administration of suitable antibiotics, critical care, and special therapeutic measures.

Keywords: Meningococcal disease, meningococcemia, meningitis, children, scoring system.

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