Extremity pain and refusal to walk in children with invasive meningococcal disease

D. O'Leary, S. H. Inkelis, V. Wang, R. Malley, M. K. Nicholson, N. Kuppermann

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Abstract

Background: Invasive meningococcal disease (IMD) remains a cause of significant morbidity and mortality amongst children. Early recognition and treatment may be lifesaving, although identifying children with IMD may at times be difficult. Extremity pain, other than that caused by arthritis, and refusal to walk, are uncommonly mentioned as clinical findings in children presenting with IMD. Objective: To determine the frequency of extremity pain or refusal to walk as clinical presentations in children with IMD. Methods: We reviewed the medical records of 272 patients younger than 20 years of age with meningococcal bacteremia and/or meningitis from 1985-1996 at three pediatric referral centers. All of these patients had positive blood or cerebrospinal fluid cultures or latex agglutination tests of the blood or CSF for N. meningitidis. From these patients, we identified those with history or physical examination (PE) findings of extremity pain or refusal to walk at presentation. Comparisons between patients with and without extremity pain or refusal to walk were performed using Fisher's exact test. Results: 45 (17%) of the 272 patients presented with either history or PE evidence of extremity imolvement, including 18 children who refused to walk. Of the 18 patients refusing to walk, 6 had no other associated extremity complaints and 12 had associated complaints of joint pain, back pain and/or not wanting to use an extremity. Of the remaining 27 patients with extremity involvement, 5 had myalgias or achiness, 5 had muscle and joint pain, 8 had joint pain and /or swelling alone, 2 had extremity pain, 6 had extremity and muscle pain, and 1 had extremity and back pain. 22 (49%) of the 45 patients had a history of extremity pain or refusal to walk but no evidence of extremity involvement on PE. 31 (84%) of the 37 patients with extremity pain or refusal to walk who had lumbar punctures performed had meningitis (defined as CSF WBC ≥10 or positive CSF culture) compared to 161 (82%) of the 197 who had no extremity pain and did not refuse to walk (p=1.0). 12 (86%) of the 14 patients who refused to walk and had lumbar punctures performed had meningitis compared to 180 (82%) of 220 patients who did not refuse to walk (p=1.0). Conclusion: Children with invasive meningococcal disease commonly present with extremity pain or refusal to walk. Although these symptoms and signs are non-specific, they should heighten the clinician's suspicion of invasive meningococcal disease.

Original languageEnglish (US)
Pages (from-to)68A
JournalJournal of Investigative Medicine
Volume47
Issue number2
StatePublished - Feb 1999

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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O'Leary, D., Inkelis, S. H., Wang, V., Malley, R., Nicholson, M. K., & Kuppermann, N. (1999). Extremity pain and refusal to walk in children with invasive meningococcal disease. Journal of Investigative Medicine, 47(2), 68A.