ABSTRACT
Meningococcal infections are an important cause of mortality and morbidity in childhood. Herein we report a 2-year-old Syrian refugee boy living in Turkey diagnosed with Neisseria meningitidis serotype B infection complicated with intracranial empyema. Refugees are a sensitive population in all aspects especially infectious diseases. Endemic diseases in the refugees’ own countries constitute a major health problem. Vaccination in sensitive populations and in the country would be important precaution to decrease disease burden.
KEYWORDS:
To the editors,
Meningococcal infections are an important cause of pediatric mortality and morbidity. Approximately 60% of meningococcal diseases in US children under age 5 years is caused by serogroup B,Citation1 which also has a similar burden in Turkey. In this case, we report a persistent meningitis case admitted with fever and confusion, diagnosed as N. meningitidis serotype B complicated with intracranial empyema. Refugees have increased risk factors such as not achieving primary health services systematically.
We report a 2-year-old Syrian refugee boy living in Turkey, admitted to the hospital with vomiting, confusion, and fever for 2 days. Ceftriaxone and acyclovir therapy were initiated given that confusion and stiff neck were present. Lumbar puncture for taking a CSF sample revealed CSF glucose: 1 mg/dL (same time blood glucose: 59 mg/dL), protein: 353 mg/dL, Cl: 121 mmol/L; CSF gram staining yielded lots of gram-negative diplococcus. N. meningitidis serotype B was cultured. The patient still had fever after 1 week of therapy, Cranial MRI showed that both cerebral hemispheres, especially parieto-occipital lobs T2A and Flair scenes, had hyperintensity that caused by infection, empyema. Therapy was switched to meropenem and continued for 6 weeks in total. Control imaging showed complete cure.
N. meningitidis is one of the most important causes of bacterial meningitis in infants and young children. The etiology of bacterial meningitis in Turkey has been changed after the introduction of conjugated vaccines for Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) in the Turkish national vaccination schedule. In a prospective study conducted in 927 children with suspected meningitis, 59 N. meningitidis isolates were detected in 77 samples There were four deaths in this study, all caused by N. meningitidis serogroup B.Citation2 Our experience with meningococcal disease in our hospital is also similar.Citation3 We would like to emphasize that repeated imaging might be needed in nonresponsive cases with meningitis. Moreover, since refugees are a sensitive population, it is important to implement new strategies in the health care of refugees.Citation3 Moreover vaccination with very high coverage in sensitive populations and all over the country would be beneficial to decrease carriage of vaccine and nonvaccine serotypes of meningococcus. Finally, national surveillance studies are important given that meningococcal epidemiology is dynamic and needs to be closely monitored to detect changes over the course of years.
Disclosure of potential conflicts of interest
No potential conflicts of interest were disclosed.
References
- Cohn AC, MacNeil JR, Clark TA, Ortega-Sanchez IR, Briere EZ, Meissner HC, Baker CJ, Messonnier NE; Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013 Mar 22;62(RR–2):1–28.
- Ceyhan M, Ozsurekci Y, Bayhan C, Gurler N, Sali E, Emiroglu MK, Öz FN, Camcioglu Y, Salman N, Kurugol Z, et al. The changing epidemiology of bacterial meningitis during 2015–2017 in Turkey: a hospital-based prospective surveillance study. Open Forum Infect Dis. 2018 Nov;5(Suppl 1):S246. doi:10.1093/ofid/ofy210.689.
- Ozkaya-Parlakay A, Kanik-Yuksek S, Gulhan B, Tezer H, Altay F, Unal-Sahin N. A refugee patient with meningococcal meningitis type B. Hum Vaccin Immunother. 2018;14(9):2329. doi:10.1080/21645515.2018.1471307.