Características clínicas y factores pronósticos de la enfermedad meningocóccica: un estudio de serie de casos en Chile durante el brote 2012-2013

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate. Introduccion: La enfermedad meningococcica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentacion clinica inespecifica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolucion y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Metodo: Serie de 149 casos de EM de siete regiones. Se aplico un cuestionario y se revisaron registros clinicos, incluyendo variables del individuo, agente, curso clinico y proceso de atencion. Los analisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presento como meningococcemia, la letalidad alcanzo a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, sintomas cardiovasculares, baja saturacion de oxigeno y bajo puntaje de Glasgow. Discusion: La letalidad supero las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de sintomas inespecificos o a la rapida progresion a septicemia, impacto en un sistema de salud habituado a cuadros mas clasicos de EM, lo que podria explicar en parte, la mayor letalidad observada.