C Aydin, F Genel, I Devrim, S Gozmen, O Olukman

Abstract

Introduction: Acute bacterial meningitis (ABM) and meningococcemia are among the most serious causes of mortality and morbidity in children. Faster tests with high specificity and sensitivity are required to provide early diagnosis and better prognosis. This study aimed to get serial measurements of monocyte HLA-DR expression rate to evaluate the outcome and prognostic value in children with ABM and meningococcemia. Population and Methods: This prospective case-control study was carried out on 18 paediatric patients diagnosed as ABM and meningococcemia and 36 healthy controls between 2011-2017 at Dr. Behcet Uz Children's Hospital, Izmir, Turkey. Monocyte HLA-DR expression was determined by flow cytometry on admission and the third day of treatment. Results: In the study group, HLA-DR expression was significantly low both on admission and on day 3, as well as HLA-DR mean fluorescence intensity (p<0.001, p=0.001, p=0.001, respectively). When compared to the third day of treatment, monocyte HLA-DR expression was significantly lower on admission (p=0.003). Five patients suffered neurological complications. On day 3, monocyte HLA-DR expression was found significantly lower in patients with neurological complications than the ones with a normal neurological examination (p=0.043). Six patients had used antibiotics before admission. Patients without prior antibiotic usage showed significantly lower monocyte HLA-DR expression (p=0.007). Conclusions: Monocyte HLA-DR expression is down-regulated in patients with ABM and meningococcemia. Higher percentages of monocytes expressing HLA-DR in patients with prior antibiotic treatment supports the importance of early treatment. Low monocyte HLA-DR expression on day 3 also seems to be a valuable predictive marker for neurological complications.