Meningococcal Sepsis

Meningokokna sepsa spada u skupinu invazivnih meningokoknih bolesti i zbog svoje naravi oduvijek je izazivala poseban oprez među kliničarima. Uzrokovana je gram negativnim diplokokom, Neisseriom meningitidis i to najčešće serogrupama A, B, C, X, Y i W135. Zahvaljujući raznovrsnim čimbenicima virulencije meningokok vrlo uspješno savladava imunološke napore organizma domaćina i uzrokuje bolest koja najčešće pogađa djecu dojenačke dobi. Klinička slika u početku ove bolesti nije specifična. Hemoragični osip koji se nekada smatrao patognomoničnim znakom ne razvija se u gotovo četvrtine bolesnika, a isprva ne mora biti petehijalan niti blijediti na pritisak. Simptomi koji sugeriraju razvoj sepse uključuju jake bolove u nogama, hladne okrajine te blijedu i marmoriziranu kožu. Liječenje predstavlja složeni medicinski postupak koji uključuje antibiotsku i suportivnu terapiju. S obzirom da bolest može u kratkom periodu promijeniti svoj karakter i ozbiljnost, opravdano je administrirati antibiotik (ceftriakson) već pri najmanjoj sumnji. Iako se radi o rijetkoj bolesti, zbog visoke smrtnosti, učestalosti komplikacija i težine posljedica koje može ostaviti u preživjelih, meningokokna sepsa i dalje predstavlja javnozdravstveni problem. Usprkos postojanju učinkovitih cjepiva, u Hrvatskoj se primarna prevencija aktivnom imunizacijom ne provodi rutinski, odnosno nije sastavnica aktualnog kalendara cijepljenja. Cilj ovog rada jest osvijestiti činjenicu da u diferencijalno dijagnostičkom razmišljanju kod nejasnog febrilnog stanja u djeteta s poremećenim općim stanjem uvijek treba imati na umu meningokoknu bolest.Meningococcal sepsis belongs to the group of invasive meningococcal diseases and due to its nature has always caused special caution among clinicians. It requires urgent recognition of symptoms and adequate care, often in intensive care units. It is caused by gram-negative diplococci, Neisseria meningitidis, most often in serogroups A, B, C, X, Y and W135. Due to various virulence factors, meningococcus very successfully overcomes the immune efforts of the host. The disease most commonly affects infants. The clinical presentation at the beginning of the disease is not specific. Hemorrhagic rash once considered a pathognomonic sign, does not develop in nearly a quarter of patients, and may not initially be petechial. Symptoms that suggest the development of sepsis include severe pain in the legs, cold extremities and pale skin. Treatment includes complex medical procedures like antibiotic and supportive therapy. Since the disease can change its character and severity in a short period of time, it is rational to administer an antibiotic (ceftriaxone) even if there is slightest suspicion. Despite the fact that it is a rare disease, due to high mortality, frequency of complications and severity of the consequences in survivors, meningococcal sepsis remains a public health concern. In Croatia primary prevention by active immunization is not carried out routinely, it is not a component of the current vaccination calendar. The aim of this paper is to raise awareness of the fact that meningococcal disease should always be kept in mind in differential diagnostic thinking in case of unclear febrile condition in a child with a poor general condition