Systematic review of invasive meningococcal disease epidemiology in the Eastern Mediterranean and North Africa region

Table 3 Symptoms, complications and sequelae

a) Acute symptoms
Region	EM						NA
Country	Iran [106]	Iran [91]	Qatar [69]	Turkey [97]	Turkey [107]	Saudi Arabia [71]	Egypt [78]^b	Morocco [104]
Population type	GP	GP	GP	GP	GP	P	GP	GP
Number of patients in study	3	68	25	65	7	105	203	35
Date range, year	2009–2011	1992–2002	1992–2008	2000–2005	1995–2003	February–April 2000	1998–2004	2011–2013
Age range, year	Children (0.5–10)	Children (0–13)	Children, adults (0–68)	Children (0.5–10)	Children, adults (15–60)	Adults (18–80)	Children, adults (0–75)	Children (0–13)
Symptoms
Proportion of patients experiencing acute symptoms (%)	0.0–100	8.8–64.7	4.0–80.0	7.7–95.4	71.4	28.6	16.0–79.0	5.7–65.7
Stiff neck	100	55.9	52.0				79
Rash	0	64.7	28.0		71.4	28.6	16	65.7
Fever	66.7		80.0	95.4
Meningeal irritation syndrome^a	66.7
Seizure	66.7	8.8	4.0–12.0	7.7				11.4
Headache		55.9	48.0				66.0	31.4
Vomiting			56.0					40.0
Altered consciousness			48.0	27.7
Diarrhoea				9.2				11.4
Purpura				92.3
Photophobia							37
Neck pain								17.1
Abdominal pain								5.7
Lethargy								48.6
Irritability								8.6

b) Complications at admission and acute complications
Region	EM		NA
Reference	Iran [91]	Turkey [97]	Morocco [104]
Population type	GP	GP	GP
Number of patients in study	68	65	35
Date range, year	1992–2002	2000–2005	2011–2013
Age range, year	Children (0–13)	Children (0.5–10)	Children (0–13)
Complications at admission and acute complications
Proportion of patients experiencing complications at admission and acute complications (%)	2.9–38.2	3.1–38.5	11.4–54.3
Septic shock	38.2	38.5
Conjunctivitis	2.9
Pericarditis	2.9
Myocarditis		4.6
Purpura fulminans		4.6
Acute renal failure		3.1
ARDS		3.1
Arthralgia			11.4
Hemodynamic disorder/sepsis			54.3

c) Post-discharge complications/sequelae
Region	EM								NA
Reference	Kuwait [93]	Kuwait [94]	Qatar [69]	Qatar [52]	Saudi Arabia [124]	Saudi Arabia [71]	Turkey [98]	Turkey [99]	Egypt [78]	Tunisia [89]
Population type	GP	GP	GP	GP	GP	P	GP	GP	GP	GP
Number of patients in study	30	10	25	2	37	105	2	15	203	79
Date range, year	2001–2003	2010–2014	1992–2008	1998–2000	1999–2001	February–April 2000	1994–2004	2012–2016	1998–2004	1997–2006
Age range, year	Children (0–12)	Children (0–12)	Children, adults (0–68)	Children, adults (0–100)	Children (0–5)	Adults (18–80)	Children (2–4)	Children (0–18)	Children, adults (0–75)	Children (0–13)
Post-discharge complications and sequelae
Proportion of patients experiencing post-discharge complications/sequelae (%)	3.4	0	4.0–24.0	0	2.7	1	50	33.3	5	1.3–7.6
Hearing impairment	3.4									3.8
Motor palsy	3.4
Aphasia			8.0
Limb weakness			8.0
Focal findings			16.0
Cranial nerve palsy			4.0					33.3
Amputation							50.0			1.3
Neurological complication									5.0
Skin necrosis										7.6
Non-specific sequelae		0.0	24.0	0.0	2.7	1.0

All studies are cross-sectional unless otherwise stated
ARDS acute respiratory distress syndrome, EM Eastern Mediterranean region, GP general population, NA North Africa region, P pilgrims
^aMeningeal irritation syndrome encompasses Kernig’s sign and Brudzinski’s sign [123]
^bSurveillance study

ISSN: 1471-2334