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Table 3 Symptoms, complications and sequelae

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

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