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      An Unexpected Fever Post Serogroup B Meningococcal Sepsis

      case-report

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          Abstract

          This case report describes an invasive meningococcal group B infection followed by the development of Kawasaki disease (KD) complicated by macrophage activation syndrome (MAS) in a 2-year-old child. The presented case indicates the possible etiologic relationship between meningococcal sepsis and KD as support of bacterial toxin induced theory. It’s important to maintain a high grade of suspicious for KD in every relapse of fever also during convalescence phase of severe infection. Usually, initial treatment with intravenous immunoglobulin is sufficient to control the disease; but, in case of refractory KD complicated by MAS, corticosteroid therapy represents a good option inducing prompt fever resolution and clinical improvement.

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          Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.

          J Newburger, M. Takahashi, M Gerber … (2004)
          Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for > or =5 days and < or =4 classic criteria should undergo echocardiography [correction], receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-alpha antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.
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            Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease.

            Tohru Kobayashi, Yoshinari Inoue, Kazuo Takeuchi … (2006)
            In the present study, we developed models to predict unresponsiveness to intravenous immunoglobulin (IVIG) in Kawasaki disease (KD). We reviewed clinical records of 546 consecutive KD patients (development dataset) and 204 subsequent KD patients (validation dataset). All received IVIG for treatment of KD. IVIG nonresponders were defined by fever persisting beyond 24 hours or recrudescent fever associated with KD symptoms after an afebrile period. A 7-variable logistic model was constructed, including day of illness at initial treatment, age in months, percentage of white blood cells representing neutrophils, platelet count, and serum aspartate aminotransferase, sodium, and C-reactive protein, which generated an area under the receiver-operating-characteristics curve of 0.84 and 0.90 for the development and validation datasets, respectively. Using both datasets, the 7 variables were used to generate a simple scoring model that gave an area under the receiver-operating-characteristics curve of 0.85. For a cutoff of 0.15 or more in the logistic regression model and 4 points or more in the simple scoring model, sensitivity and specificity were 86% and 67% in the logistic model and 86% and 68% in the simple scoring model. The kappa statistic is 0.67, indicating good agreement between the logistic and simple scoring models. Our predictive models showed high sensitivity and specificity in identifying IVIG nonresponders among KD patients.
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              Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease.

              Kimiyasu Egami, Hiromi Muta, Masahiro Ishii … (2006)
              The objective of this study was to find the predictors and generate a prediction score of resistance to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD). Patients diagnosed as having KD were sampled when they received initial high-dose IVIG treatment (2 g/kg dose) within 9 days of illness (n = 320). These patients were divided into 2 groups: the resistance (n = 41) and the responder (n = 279). The following data were obtained and compared between resistance and responder: age, sex, illness days at initial treatment, and laboratory data. Multivariate logistic regression analysis identified age, illness days, platelet count, alanine aminotransferase (ALT), and C-reactive protein (CRP) as significant predictors for resistance to IVIG. We generated prediction score assigning 1 point for (1) infants less than 6 months old, (2) before 4 days of illness, (3) platelet count or= 8 mg/dL, as well as 2 points for (5) ALT >or= 80 IU/L. Using a cut-off point of 3 and more with this prediction score, we could identify the IVIG-resistant group with 78% sensitivity and 76% specificity. Resistance to IVIG treatment can be predicted using age, illness days, platelet count, ALT, and CRP. Randomized, multicenter clinical trials are necessary to create a new strategy to treat these high-risk patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pediatr Rep
                Journal ID (iso-abbrev): Pediatr Rep
                Journal ID (publisher-id): PR
                Title: Pediatric Reports
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2036-749X
                ISSN (Electronic): 2036-7503
                Publication date (Electronic): 17 November 2016
                Publication date Collection: 17 November 2016
                Volume: 8
                Issue: 4
                Electronic Location Identifier: 6613
                Affiliations
                [1 ] Pediatric Infectious Diseases Division, University of Padua , Italy
                [2 ] Pediatric Pulmonology and Allergy Division, University of Padua , Italy
                [3 ] Pediatric Diabetology Division, Department for Woman and Child Health, University of Padua , Italy
                Author notes
                Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35124 Padua, Italy. +39.338.8946412. daniele.dona@ 123456phd.unipd.it.

                Contributions: DD drafted the initial manuscript; EG, CG and CM reviewed and revised the manuscript and approved the final manuscript as submitted.

                Conflict of interest: the authors declare no potential conflict of interest.

                Article
                DOI: 10.4081/pr.2016.6613
                PMC ID: 5136770
                PubMed ID: 27994836
                SO-VID: 10e38877-a38a-420f-82da-d64dd43f4b83
                Copyright © ©Copyright D. Donà et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 May 2016
                Date revision received : 20 October 2016
                Date accepted : 24 October 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 3
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Pediatrics
                Keywords: neisseria meningitidis serogroup b,kawasaki diseases,corticosteroid therapy macrophage activation syndrome
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: neisseria meningitidis serogroup b, kawasaki diseases, corticosteroid therapy macrophage activation syndrome

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