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The incidence of immune complex associated complications of severe meningococcal disease such as arthritis, vasculitis, and pleuritis, has not declined despite better treatment. The documented incidence in the literature is 6–11%, although there has not been a report on a large patient group for over 20 years. A recent Dutch survey has found the incidence to be 15%.
The Dutch survey from a paediatric intensive care unit was conducted between January 1993 and August 2000. It found that of 130 survivors of meningococcal disease followed up retrospectively, 20 (15%) developed immune complex associated complications. These complications usually occur 4–10 days after initial antibiotic treatment and typically present with local clinical symptoms and a recurrence of fever.
Eighteen children had arthritis, 11 vasculitis and five pleuritis. Twelve patients had more than one complication. All had fever, leucocytosis, and increased C reactive protein. They were also found to have a significantly lower leucocyte count at admission than children who did not go on to develop any immune-mediated complications.
In patients with secondary fever or raised inflammatory parameters following meningococcal disease, immune complex associated complications should always be considered in the differential diagnosis. The high incidence found in this study compared to that reported in the literature may be due to the fact that the children studied were more severely ill. A prospective study is now needed to identify risk factors for these sorts of complications following severe meningococcal disease.
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