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Research | DOI: https://doi.org/10.31579/2768-2757/190
1State Budgetary Healthcare Institution "Bratsk Children's City Hospital", Russia, Irkutsk Region.
2Irkutsk State Medical University, Russia, Irkutsk.
3Regional State Budgetary Healthcare Institution "Bratsk District Hospital".
4KDRTs "Sanad" LLP, Kazakhstan, Karaganda.
*Corresponding Author: Daro Bratsk., State Budgetary Healthcare Institution
Citation: Ermachenko M.F., Zemin Yu. A., Ivanov R.A., Sergeeva L.I., Nomokonov V.I, et al, (2025), A Resuscitation Specialist's View of The Problems Arising in The Treatment of Generalized Meningococcal Infection in Children, Journal of Clinical Surgery and Research, 6(7); DOI:10.31579/2768-2757/190
Copyright: © 2025, Daro Bratsk. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 20 October 2025 | Accepted: 05 November 2025 | Published: 20 November 2025
Keywords: meningococcal infection; figures; diagnosis; infectious-toxic
Meningococcal disease is an anthroponotic disease transmitted by meningococcal carriers, patients with meningococcal nasopharyngitis, and generalized forms of the infection. Transmission is via airborne droplets and household contact. The incubation period is 1-7 days. [1]. Meningococcal infection is characterized by a periodicity, with intervals of 10-20 years between peaks, which, according to our observations, has recently become apparent and underscores the relevance of this problem. Children (70-80%) and young adults are predominantly affected.
Meningococcal infection has a pronounced seasonal nature, is characterized by an acute onset and, despite treatment, often ends fatally due to the development of complications (septic shock, meningococcal meningitis, adrenal damage, cerebral edema) [1, 3, 8, 9, 10, 11]. Most fatalities occur within 1-2 days of illness from fulminant (hypertoxic) meningococcemia, and less commonly from the mixed (meningitis and meningococcemia) form of infection. In these forms, hemorrhages into the adrenal glands (Waterhouse-Fredericksen syndrome) are most common, leading to the development of refractory septic shock and causing death in almost 100% of victims. [3, 8, 9, 10]. According to the data of the information and analytical review prepared in 2022 by the Russian Reference Center for Monitoring Bacterial Meningitis at the Central Research Institute of Epidemiology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, the incidence and mortality from meningococcal infection have a decreasing trend. [17] However, despite the fairly well-studied characteristics of meningococcal infection, its etiology, pathogenesis, and seemingly proven treatment regimens, in 2022 the incidence of GFMI increased by 2 times, amounting to 0.44 per 100 thousand population. In addition, in 2022 the mortality rate from GFMI increased, amounting to 16% (for comparison, in 2020 - 12%). According to the state report of Rospotrebnadzor, in 2024 the incidence rate of generalized forms of meningococcal infection (GFMI)amounted to 0.47 per 100 thousand population [12]. According to some authors, the mortality rate for septic shock developing against the background of meningococcal infection reaches 100%, and a fatal outcome in the overwhelming majority of cases (90.9%) occurs within the first 24 hours of hospitalization [8]. It is characteristic that other authors also cite practically identical figures in their studies [9]. These data confirm the particular severity of the infection and the need for timely, adequate care for patients with meningococcal infection.
To analyze the causes of fatal outcomes of generalized forms of meningococcal infection using the example of the intensive care unit of the Bratsk Children's City Hospital for the period from 1988 to 2024.
During the analyzed period (1988-2024), 119 children with the diagnosis of generalized meningococcal infection, meningococcemia and/or meningococcal meningitis, and/or mixed form, including 10 with a fulminant form, were treated in the intensive care unit of the Bratsk Children's City Hospital. The years (2009, 2011, 2014, 2019) when patients with meningococcal infection were not admitted to the intensive care unit are noted. The average age of patients was 1.4 years (min - 4 months, max - 11 years). Boys - 54.6% (65 patients), girls - 45.4% (54 patients). The average bed-day in the intensive care unit was 4 days (min – 1 bed-day, max – 14 bed-days). The mortality rate in this group of patients was 12.6% (15 patients), which is comparable with data from the Federal Budgetary Institution of Health "Center for Hygiene Education of the Population" of Rospotrebnadzor [16].
| Cause of death: | Period 1988 – 2024 |
| Lightning form, ITSH (III – IV century) | 10 |
| Late hospitalization | 2 |
| Severe concomitant pathology | 1 |
| Incorrect tactics at the pre-hospital stage | 1 |
| Incorrect hospital tactics | 1 |
| Total: | 15 |
Table 1: The main causes of deaths are reflected in Table No. 1
Our data show that the most common cause of death is the rapid progression of meningococcal infection (in 10 of 15 cases), with the development of refractory septic shock, with or without Waterhouse-Frederichsen syndrome (adrenal hemorrhage). In these cases, even appropriate prehospital and in-hospital management failed to produce the desired results.Late hospitalization resulted in underestimation of the child's condition during the pre-hospital phase. Symptoms such as high fever, nonspecific signs of intoxication (lethargy, weakness, headache, loss of appetite) in the absence of characteristic skin rashes, meningeal symptoms, and vomiting are sometimes misinterpreted as signs of acute respiratory viral infection. In these cases, appropriate treatment is prescribed with a recommendation for a follow-up examination by a local physician the following day. This lost time resulted in two fatal outcomes; in both cases, the children were hospitalized only after a second call to the ambulance. In one case, the cause of death was the administration of penicillin during the prehospital phase. The diagnosis of meningococcal infection was correct, but the administration of a bactericidal antibiotic without considering the risk of endotoxinemia led to the development of refractory septic shock. The cause of death, related to improper hospital management, was the early discontinuation of chloramphenicol and the switch to penicillin. The patient's general condition 36 hours after treatment was mistakenly assessed as severe with improvements (decreased temperature, no new rash, adequate diuresis, and relatively stable hemodynamics despite the use of cardiotonic agents). The administration of penicillin led to a deterioration in the patient's condition, a return of shock symptoms, and ultimately, death. Taking into account the analyzed period, we compared modern approaches to the treatment of meningococcal infection and treatment regimens used in our department in earlier years. Before the introduction of Clinical Guidelines (CG) for the treatment of meningococcal infection in children, in our practice we used the methodological recommendations of the Ministry of Health of the RSFSR of the Leningrad Research Institute of Children's Infections dated January 16, 1985, "Meningococcal Infection in Children (Clinical Features, Diagnosis, Treatment)", which included the administration of massive doses of glucocorticosteroids, the administration of antibiotics, infusion therapy, antithrombotic therapy, as well as a detailed symptomatic treatment. From the perspective of a resuscitation specialist or intensive care physician, these guidelines placed somewhat more emphasis on preventing severe complications of meningococcal infection than current clinical guidelines. For example, if a patient presented with symptoms of septic (infectious-toxic) shock, the initial therapy recommended was the administration of bacteriostatic chloramphenicol (IV) at a dose of 80-100 mg/kg/day, either intramuscularly or intravenously, with a 6-hour interval for 24-48 hours. These recommendations were justified by the significant risk of worsening the condition and causing death due to possible endotoxemia associated with the use of bactericidal antibiotics (penicillin) before the patient recovered from shock. As resuscitation specialists, we believe this approach to treatment is pathogenetically justified, and the cases and causes of death we cited, in our opinion, support this view. Unfortunately, intensive care physicians are well aware of the complexity of treating septic shock, the mortality rate of which remains very high today [15]. Treating septic shock, even in a hospital setting, is a challenging task in all countries [1, 2, 3, 4, 5, 6, 7, 10, 11]. In our opinion, the development of septic shock at the prehospital stage significantly increases the risk of an unfavorable outcome. In this regard, we believe it is very important and appropriate to use current recommendations to administer antibacterial drugs only when rapid (up to 90 minutes) hospitalization is impossible, at least in some patients (suspected meningitis, absence of hemorrhagic rash). However, parenteral use of chloramphenicol is currently extremely limited due to its toxicity and the potential for severe adverse reactions, as reflected in current guidelines for meningococcal infection. Indeed, data from various studies necessitate a serious reconsideration of previously existing approaches to antibacterial therapy. The incidence of irreversible aplastic anemia following oral or intravenous chloramphenicol use is known to vary widely among different investigators and is estimated to range from 1:6,000 to 1:45,000 cases of use [13]. According to the Scottish Antimicrobial Prescribing Group, the incidence of aplastic anemia in patients taking chloramphenicol is estimated to be 1 in 24,000–40,000 patients and is often dose-independent. Only 22% of cases of aplastic anemia developed during or shortly after treatment. In other cases, this severe complication arose weeks and even months after the treatment [14]. Currently, according to the State Register of Medicines, there is no approved parenteral form of chloramphenicol in the Russian Federation. We can note that, fortunately, over the years of parenteral use of chloramphenicol, we have never observed any such adverse reactions. At the same time, in our neighboring Republic of Kazakhstan, intravenous chloramphenicol is approved for use and is included in clinical guidelines for the treatment of meningococcal infection [16]. In our opinion, the previously accepted prescription of antithrombotic therapy deserves special attention. Current guidelines note the potential for serious complications of meningococcal infection, such as deep necrosis and mummification of the distal extremities. Surgical treatment is recommended, with no options for preventing these complications. This problem remains relevant today, as evidenced by the following example from the UK: A 3-year-old girl was called to see a doctor because of fever, drowsiness, and a rash. The doctor suspected meningococcal infection and administered an intramuscular injection of penicillin. Her condition worsened, with altered consciousness, shock, and widespread purpura. The child was urgently hospitalized in the intensive care unit, where microscopy of the skin area affected by the purpura revealed meningococci. Multiple organ failure required inotropic support and mechanical ventilation. Three fingers of her left hand were amputated due to necrosis. Five days later, the child's condition improved, and she was transferred from the intensive care unit. [2] Similar complications have been described elsewhere [6]. Antithrombotic therapy was not used in this case. During the specified observation period, we managed to avoid such complications in our practice. We believe this was facilitated by the use of heparin at a dose of 150-300 U/kg/day intravenously, depending on the patient's age and weight, as well as clinical and laboratory data. In our opinion, the use of heparin in the treatment of generalized forms of meningococcal infection, in the setting of DIC syndrome, is pathogenetically justified, of course, taking into account the clinical situation and known contraindications.
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Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
