Invasive Meningococcal Disease: Application of Base Excess and Platelets Score in a Portuguese Paediatric Intensive Care Unit.

INTRODUCTION: Meningococcal infection has a high mortality and morbidity. Recently a new prognostic scoring system was developed for paediatric invasive meningococcal disease, based on platelet count and base excess â base excess and platelets score. The main objective of this study was to evaluate the accuracy of base excess and platelets score to predict mortality in children admitted to intensive care due to invasive meningococcal disease. MATERIAL AND METHODS: Observational study, with retrospective data collection, during a 13.5 years period (01/2000 to 06/2013). Mortality by invasive meningococcal disease and related factors (organ dysfunction and multi-organ failure) were analysed. The base excess and platelets score was calculated retrospectively, to evaluate its accuracy in predicting mortality and compared with Paediatric Risk of Mortality and Paediatric Index of Mortality2. RESULTS: Were admitted 76 children with invasive meningococcal disease. The most frequent type of dysfunction was cardiovascular (92%), followed by hematologic (55%). Of the total, 47 patients (62%) had criteria for multi-organ failure. The global mortality was 16%. Neurologic and renal dysfunction showed the strongest association with mortality, adjusted odds ratio 315 (26 - 3 804) and 155 (20 - 1 299). After application of receiver operating characteristic curves, Base Excess and Platelets score had an area under curve of 0.81, Paediatric Index of Mortality2 of 0.91 and Paediatric Risk of Mortality of 0.96. DISCUSSION: The Base Excess and Platelets score showed good accuracy, although not as high as Paediatric Risk of Mortality or Paediatric Index of Mortality2. CONCLUSIONS: The Base Excess and Platelets score may be useful tool in invasive meningococcal disease because is highly sensitive and specific and is objectively measurable and readily available at presentation.

Introdução: A infeção meningocócica tem uma elevada mortalidade e morbilidade. Recentemente foi desenvolvido um score de prognóstico para a doença meningocócica invasiva em idade pediátrica, baseado na contagem plaquetar e no excesso de base - o Base Excess and Platelets Score. O objetivo principal desde estudo foi avaliar a precisão prognóstica do Base Excess and Platelets Score em doentes admitidos em cuidados intensivos pediátricos por doença meningocócica invasiva.Material e Métodos: Estudo observacional, com colheita de dados retrospetiva, que incluiu um período de 13,5 anos (01/2000 a 06/2013). Foram analisados: mortalidade por doença meningocócica invasiva e fatores associados (disfunção de órgão e falência multi-órgão). Foi calculado o Base Excess and Platelets Score de forma retrospetiva, para avaliar a sua precisão na predição da mortalidade e foi comparado com o Paediatric Risk of Mortality e Paediatric Index of Mortality2.Resultados: Foram admitidas 76 crianças com doença meningocócica invasiva. O tipo de disfunção mais frequente foi a cardiovascular (92%), seguida da hematológica (55%). Cumpriram critérios de falência multi-órgão 47 doentes (62%). A mortalidade global foi de 16%. A disfunção neurológica e a renal foram as que apresentaram uma maior associação com a mortalidade, odds ratio ajustado 315 (26 - 3 804) e 155 (20 - 1 299). Após aplicação das curvas receiver operating characteristic, o Base Excess and Platelets Score tinha umaarea under curve de 0,81, o Paediatric Index of Mortality2 de 0,91 e o Paediatric Risk of Mortality de 0,96.Discussão: O Base Excess and Platelets Score apresentou uma boa precisão apesar de não tão elevada como o Paediatric Index of Mortality2 ou o Paediatric Risk of Mortality.Conclusões: O Base Excess and Platelets Score pode ser útil como indicador prognóstico na doença meningocócica invasiva, por apresentar uma elevada sensibilidade e especificidade e ser objetivo e rapidamente disponível na admissão.

[Corynebacteria D2 and encrusted cystitis with alkaline urine]. / Corynébactéries D2 et cystite incrustée à urines alcalines.

In the light of an informative clinical case report, the authors emphasise the pathogenic role of Corynebacteria D2 in urinary tract disease. This microorganism can be easily detected by bacteriologists by the use of special media and such infection is suggested clinically by urinary tract infection with "sterile", strongly alkaline urine. The clinical features of incrusted cystitis with alkaline urine may be accompanied by serious upper urinary tract complications with renal failure, recurrent haematuria with anaemia, decreased bladder capacity and incontinence. Corynebacteria D2, an opportunistic pathogenic bacteria, responsible for nosocomial infection, is resistant to the majority of antibiotics. The authors complete their case report with a review of the literature.