BACKGROUND Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. METHODS Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. RESULTS In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15-24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5-14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. CONCLUSIONS Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.

中文翻译：

---

主要包膜人群在英格兰引起浸润性脑膜炎球菌疾病的临床表现不一。

背景技术侵袭性脑膜炎球菌病（IMD）通常表现为脑膜炎，败血病或两者兼而有之。非典型的临床表现很少见，但描述得很好。我们旨在评估2014年在英格兰诊断出的IMD病例中脑膜炎球菌荚膜组，年龄，临床表现，诊断和结局之间的关系。方法英格兰公共卫生部在英格兰进行了增强的IMD国家监测。实验室确认的≥5岁的MenB，MenW和MenY病例的临床数据用于分类表现症状，诊断和结果。多变量logistic回归用于评估脑膜炎球菌荚膜组，临床表现，性别，年龄和死亡之间的独立关联。结果2014年，由MenB（n = 179），MenW（n = 95）和MenY（n = 66）导致了340例实验室确认的IMD病例。在MenB例中（28％）和15-24岁（20％）中，仅脑膜炎的临床表现更为普遍，而在MenY例中（26％）和≥65岁（24）中细菌性肺炎最为普遍。 ％）。15％（40/269）病例中有可用信息的胃肠道症状被记录在报告之前或期间，包括5％（7/140）MenB，17％（8/47）MenY和30％（25/82）MenW病例。在16％（22/141）MenB，23％（11/47）MenY和31％（26/84）MenW病例中报告了上呼吸道症状。年龄的增长也与细菌性脑膜炎球菌性肺炎独立相关，在5至14岁的人群中没有病例，而在65岁以上的人群中则为24％。病死率随着年龄的增长而增加，但未发现与死亡的显着相关性。