727 MENINGOCOCCIC CASES: AN ANALYSIS

Abstract

During a 4 year period (1943-1946), 727 cases of meningococcic meningitis were treated at Municipal Contagious Disease Hospital, Chicago. The meningococci were typed in 241 instances, and of these 92.9% were Type I. There were 108 deaths or a fatality rate of 14.8%. 20 of the fatalities were examples of the Waterhouse-Friderichsen syndrome. Excluding 67 patients who were moribund at the time of admission, the fatality rate for 660 patients was 6.2%. Ages for all patients ranged from 7 wks. to 71 yrs. There were 412 & [male][male] and 315 [female][female] . The average days of illness at time of admission were 3.2. Blood cultures were positive in 51.4% of 400 patients. Petechiae were present in 62.8% of all patients, and 69.8% of smears from petechiae of 153 patients were positive for meningococci. Lumbar punctures were usually made only for the purpose of establishing a laboratory diagnosis. 29.9% of all patients had no intrathecal tap. All patients were treated with one of the sulfonamides, and the initial dose was usually given intravenously. The authors emphasize that too much importance is usually at-tached to blood levels in judging the value of sulfonamide therapy. For 263 patients treated with sulfathiazole, with an average blood level of 7.1, the fatality rate was 12.8%, whereas, for 264 patients who received sulfadiazine, the average blood level was 18.9, and the fatality rate was 14.0%. Hematuria was much more common with sulfadiazine than when sulfathiazole was administered. The average duration of sulfonamide therapy for all recovered patients was 8.3 days, and the average duration of hospitalization for all recovered patients was 11.5 days. The opinion is expressed that penicillin is not a valuable adjunct in the treatment of meningococcic meningitis except in the case of eye complications. Among 22 patients who received penicillin intrathecally the fatality rate was 40.9%. This same group was treated with a sulfonamide in addition. 77 autopsies were performed, and among these lobar or bronchopneumonia was present in 22 instances, as well as the customary intracranial findings. In 11 cases the Waterhouse-Friderichsen syndrome was confirmed at necropsy. Throughout the paper, the point is stressed that intrathecal therapy is not necessary and that the primary purpose of a lumbar puncture should be for diagnosis.