Abstract

Background: Hypervirulent clonal complex (cc) have been associated with higher incidence and case fatality rate of invasive meningococcal disease (IMD) The aim of this study was to describe the clinical manifestations of the hypervirulent cc of meningococcus in children Methods: Retrospective study in patients hospitalized by IMD microbiologically confirmed at three children's tertiary health care centers in Santiago, Chile, between 2010 and 2018 Demographic, clinical information and determination of the cc and factor H binding protein (fHbp) alleles were performed Results: In total 93 cases were evaluated, sequence typing was available for 91 cases, and 87 (95.6%) had a cc assigned; 63.7% were MenW and 31.8% MenB The median age was 9 months, 67% were male and 18.7% had any comorbidity A 26.4% presented neurological deficit, 25.3% petechiae and 20% diarrhea Sixty-seven percent were admitted to the pediatric intensive care unit (PICU) and the case fatality rate was 9.9% Regarding cc and fHbp alleles, ST11, ST41/44 and allele 22 were the most frequently identified, with 63.7%, 19.8% and 72.5%, respectively We found statistically significant differences between the cc and presence of petechiae, diagnosis of meningococcemia plus meningitis, admission and days in PICU and advanced support Allele 22 for fHbp was associated with the absence of petechiae, low suspicion of IMD, less diagnosis of meningitis+meningococcemia, PICU admission, advanced support and adrenal insufficiency Conclusion: Epidemiological and microbiological surveillance of IMD should integrate clinical and laboratory components, including molecular and genetic characterization, to enrich the dynamic understanding of the clinical evolution of IMD. © 2023 Lippincott Williams and Wilkins. All rights reserved.