Meningococcal disease: clinicopathological correlation

Clinicopathological correlation studies of cases admitted as meningococcal disease are scarce, although they can serve to elucidate clinically obscure cases. 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). 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%). 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. Los estudios de correlación clinicopatológica en pacientes con infección meningocócica son infrecuentes. Estos estudios pueden facilitar el conocimiento de la patogénesis de la enfermedad meningocócica y contribuir así a mejorar el pronóstico mediante una intervención clínica precoz. Se ha realizado un estudio descriptivo de 42 necropsias realizadas a pacientes con diagnóstico clínico de infección meningocócica, correlacionando los hallazgos histopatológicos con las distintas formas de presentación de la infección. Se han definido tres formas de presentación de la infección meningocócica: sepsis (SM), sepsis y meningitis (SM-MM), y meningitis o meningoencefalitis meningocócica (MM). De los 42 p