CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF PATIENTS WITH MENINGOCOCCAL DISEASE TREATED AT THE CLINICAL DEPARTMENT FOR INFECTIOUS DISEASES OF THE UNIVERSITY HOSPITAL CENTRE SPLIT

Cilj: U ovoj retrospektivnoj studiji prikazano je 100 bolesnika s meningokoknom bolešću koji su liječeni u Klinici za infektologiju KBC Split kroz sedamnaestgodišnje razdoblje, odnosno od 1. siječnja 1996. godine do 31. prosinca 2012. godine. Cilj rada bio je prikazati epidemiološka obilježja, kliničku prezentaciju, posebno invazivni oblik bolesti, te načine liječenja na našem području. Ispitanici i metode: Ukupno je liječeno 100 bolesnika od kojih je četvero umrlo, a preostalih 96 je uspješno izliječeno. Podaci o oboljelima su prikupljeni iz pismohrane bolesnika s meningokoknom bolešću u Klinici za infektologiju KBC Split. Rezultati: U 73 % slučajeva radilo se o djeci mlađoj od 15 godina, prosječne starosti 4,95 godina, dok je preostalih 27 % bolesnika bilo starije od 15 godina. Bilo je 60 osoba muškog i 40 osoba ženskog spola. Najviše bolesnika bilo je iz Splitsko-dalmatinske županije, a znatno manje iz drugih područja Hrvatske. Bolest se klinički manifestirala kao sepsa s meningitisom u 41 % bolesnika, kao meningitis u 37 %, a kao sepsa u 22 % bolesnika. N.meningitidis najčešće se izolirala iz cerebrospinalnog likvora i to u 55 % oboljelih. Najčešća serogrupa bila je B (84 %), zatim C (11 %), dok je serogrupa W135 utvrđena u 5 % bolesniksa. Među izolatima nije uočena smanjena osjetljivost na penicilin, jedino je utvrđena rezistencija na kotrimoksazol i to kod 19 izolata. Najčešće korišten antibiotik bio je ceftriakson i to u 51 % slučajeva, a prosječno trajanje antibiotske terapije iznosilo je 7,39 dana. Komplikacije meningokokne bolesti su utvrđene u 28 % oboljelih, i to najčešće opsežne kožne nekroze kod 12 % bolesnika. Nije uočena statistički značajna povezanost spola, dobne skupine oboljelih i vremena protekloga od početka bolesti do primanja antibiotske terapije s pojavom komplikacija. Svi bolesnici su bili sporadični slučajevi, odnosno nije zabilježena niti jedna epidemija bolesti. Zaključak: Mnogi problemi u razumijevanju, prevenciji i liječenju meningokokne bolesti i dalje postoje. Ovdje svakako treba ubrojati osjetljivost određenih grupa stanovništva na ovu infekciju, sporadičnu pojavnost bolesti, povremene epidemije, nemogućnost potpune eradikacije kliconoša te posebno, nepostojanje cjepiva za najčešću serogrupu B.Objectives: In this retrospective study we considered a hundred patients suffering from meningococcal disease who were treated at the Clinical Department for Infectious Diseases of the University Hospital Centre Split over a period of seventeen years, from 1st of January 1996 to 31st of December 2012. The objective of the study was to present the epidemiologic characteristics and the clinical presentation of the particularly invasive form of the disease and the methods of treatment available in our area. Patients and Methods: In total, 100 patients were treated, of which 4 died and the remaining 96 were successfully cured. The data was collected from the records of patients with meningococcal disease at the Clinical Department for Infectious Diseases of the University Hospital Centre Split. Results: In 73% of the cases the patients were children younger than 15, with an average age of 4.95 years, whilst the remaining 27% were older than 15. There were 60 male patients and 40 female patients. Most of the patients came from the County of Split-Dalmatia, whilst a very small number came from other areas of Croatia. The disease was clinically manifested as sepsis and meningitis in 41% of the patients, as meningitis in 37% of the patients, and as sepsis in 22% of the patients. N.meningitidis was mostly isolated from the cerebrospinal fluid. This was the case in 55% of the patients. The most common serogroup was B (84%), followed by C (11%), whilst serogroup W135 was established in 5% of the patients. No reduced susceptibility to penicillin was detected in the isolates. Resistance to co-trimoxazole was determined in 19 isolates. The most used antibiotic was ceftriaxone, in 51% of the cases, and the average length of the antibiotic therapy was 7.39 days. Complications in meningococcal disease were determined in 28% of the patients, most commonly extensive skin necrosis (in 12% of the patients). No statistically significant correlation was established between the sex, the age group of the patients, the time passed from the beginning of the disease to the start of the antibiotic therapy, and the occurrence of complications. All patients were sporadic cases, that is to say not one epidemic of the disease was recorded. Conclusion: Many problems still exist in understanding, preventing and treating meningococcal disease. Particularly noteworthy are the susceptibility of certain groups of population to this infection, sporadic occurrence of the disease, occasional epidemics, impossibility of complete eradication of carriers and in particular non-existence of a vaccine for the most common serogroup, B