[Meningococcal disease: clinicopathological correlation].
Maneno muhimu
Kikemikali
BACKGROUND
Clinicopathological correlation studies of cases admitted as meningococcal disease are scarce, although they can serve to elucidate clinically obscure cases.
METHODS
A descriptive approach was used to analyze 42 necropsies following clinical diagnosis of meningococcal disease, verifying the agreement between histopathological and clinical findings evaluated according to three clinical forms of meningococcal disease (MD) in children and adults: septicemic meningococcal disease (MD-S), meningococcal disease with meningitis and septicemia (MD-MS), and meningococcal disease with meningitis/meningoencephalitis alone (MD-M).
RESULTS
Of the total, 81% met the confirmatory clinical criteria; 56% were 14 years of age or less and 44% were over 14 years. The principal causes of death included multiple organ failure (59%) (associated with shock in 65% of cases); cerebral edema (29%); and myocarditis (12%). There was a high clinicopathological correlation between septic shock and diffuse adrenal hemorrhage (77%) and between respiratory failure and pulmonary alterations (77%), and a low correlation between heart failure and cardiac involvement (27%) and between diarrhea and enteritis (25%). Myocarditis and disseminated fibrin thrombi, especially in the skin, lungs, and kidneys, predominated in the MD-S and MD-MS forms, while diffuse adrenal hemorrhage and enteritis predominated in MD-S. The correlations between the clinical and pathological diagnoses of the MD forms were: MD-S, 17/11 (65%), MD-MS, 14/14 (100%), and MD-M, 3/2 (67%).
CONCLUSIONS
There was significant correlation between clinical and pathological diagnoses (P <.0001) according to the various forms of MD. However, histopathological analysis did not differentiate between the MD-S and MD-MS forms, which merely represented variations in severity.
