Effect of treatment choice on survival in a case with meningococcemia and multiorgan failure

Year 2016, Volume: 43 Issue: 1, 177 - 180, 01.03.2016

Kadriye Özdemir , Nida Dincel Orhan Kara Ebru Yılmaz Gözde Gözüoğlu Sevgi Mir

https://doi.org/10.5798/diclemedj.0921.2016.01.0664

Cited By: 1

Abstract

We report in this paper a case had continuous veno-venous hemodiafiltration (CVVHDF) with the diagnosis of meningococcemia - multiple organ failure (MOF) and without permanent damage development although it took more than 4 weeks of loss of kidney function. Three-year-old female patient was hospitalized for unconsciousness, no spontaneous respiration, blood pressure 50/30 mmHg, and widely echimotic- purpuric rash. In her laboratory. there were 19.600 / mm3 white blood cells, 5.7 g / dL hemoglobin, 76,000 / mm3 platelets, prothrombin time was 23.9 seconds, aPTT was higher than measurable values, creatinine was 7.2 mg / dL, ALT / AST were 378/714 / L, and she was anuric. She underwent CVVHDF treatment with the diagnosis of meningococcemia and MOF. On the 48 hours of treatment, her vital signs were improved, on 55 hours MOF was revealed except for renal functions and CVVHDF treatment was discontinued. Because of the damage to the kidneys continue, she had 3 hours/ day dose of hemodialysis. At the end of hospitalization for 1 week, her hemodialysis need was declined to 3 days/ week, on 5th week to 2 days / week and on the beginning of 6 weeks, there was entirely no need for dialysis and she had been seen in services in one more week without dialysis need. On the last visit, she had normal blood pressure, creatinine clearance, urine osmolarity and protein excretion. She was followed up for 4.5 years with no abnormality.
Key words: Meningococcemia, dialysis, renal failure

Keywords

Meningokoksemi, diyaliz, böbrek yetmezliği

References

• Akil I, Yüksel H, Coskun S, et al. Fulminant meningococcemia and acute renal failure in a 3 year old boy. Pediatr Nephrol 2004;19:237-239.
• Walters S, Levin M. Infectious disease and the kidney. In:Barratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology, 4th edn. Lippincott Williams Wilkins, Baltimore, 1999;pp 1079–1101.
• Peng Y, Yuan Z, Li H. Removal of inflammatory cytokines and endotoxin by veno-venous continuous renal replacement therapy for burned patients with sepsis. Burns 2005;31:623-628.
• Jacobs FM, Brivet FG. Early venovenous haemodiafiltration for sepsis-related multiple organ failure. Crit Care Med 2005;10:755-763.
• Baines PB, Hart CA. Severe meningococcal disease in childhood.
• Br J Anesthesia 2003;90:72-83.
• Chaudhuri A, Martin PM, Kennedy PGE, et al. EFNS Task Force: EFNS guidelines on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol 2008;15:649-659.
• Booy R, Habibi P, Nadel S, et al. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arc Dis Child 2001;85:386-390
• Duzova A, Bakkaloglu A, Kalyoncu M, et al. Turkish Society for Pediatric Nephrology Acute Kidney Injury Study Group. Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 2010;25:1453-1461.
• Ronco C, Ricci Z. Pediatric continuous renal replacement: 20
• years later. Intensive Care Med 2015;41:985-993.
• Stephenson T: Clinical management of meningococcal disease: Coning may ocur without lumber puncture being done. BMJ 1997;315:774-779.
• Gulla K. M., Sachdev A., Gupta ,et al. Continuous renal replacement therapy in children with severe sepsis and multiorgan
• dysfunction - A pilot study on timing of initiation. Indian J Crit Care Med 2015;19:613-617.
• Kara OD, Dincel N, Kaplan Bulut I, et al. Success of continuous veno-venous hemodiafiltration treatment in children monitored in the intensive care units. Ren Fail 2014;36:1411-1415.
• Honore PM, Jacobs R, Joannes-Boyau O, et al. Septic AKI in ICU patients. Diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments. Ann Intensive Care 2011;1:32.
• Marotto MS, Marotto PC, Sztajnbok J, et al. Outcome of acute renal failure in meningococcemia. Ren Fail 1997;19:807-810.