Meningococcal septicaemia is an acute bacterial infection with high morbidity and mortality. The infection can cause multiple systemic manifestations including disseminated intravascular coagulation, haemorrhage, infarction and necrosis of internal organs and bone abnormalities. Children with meningococcal septicaemia present most frequently between the ages of 3 months and 5 years; a crucial period for the developing dentition. Disturbances to developing dentition are frequent sequelae of this infection and include hypoplasia and hypo/hypermineralization, failed or delayed eruption, root and crown malformation. This is thought to be related to subclinical premaxillary osteomyelitis secondary to septicaemia. This case series describes three patients with rare but similar patterns of dental development, notably in the anterior maxillary region, following meningococcal septicaemia in early childhood. The patient journey through multidisciplinary assessment and management is explored, from initial diagnosis to definitive oral rehabilitation. This article underscores the importance of effective communication and care pathways between the dental team and wider medical profession.
CPD/Clinical Relevance: To raise awareness of the impact of early childhood meningococcal septicaemia on the developing dentition and the potential need for referral to secondary dental care.
Article
Meningococcal disease presents in two forms: bacterial meningitis and septicaemia, where septicaemia accounts for approximately 25% of cases.1Neisseria meningitides, Streptococcus pneumoniae and Haemophilus influenzae type b are the leading cause of bacterial meningitis in children over 3 years of age and young adults. Paediatric patients typically present with meningococcal septicaemia between the ages of 3 months and 5 years. The incidence in infants is 16 per 100,000 and in children aged 1–4 years, this figure is 4 per 100,000.2 The infection has a high morbidity and mortality rate. Up to 20% of the children who contract severe meningococcal septicaemia die, usually within 24 hours of the first symptoms.
The infecting organisms are members of the healthy microbiome, found in the human nasopharynx and are spread via close contact, including saliva and respiratory secretions.
Complications of infection can present in multiple systemic manifestations. This can include non-specific symptoms, such as general malaise, fever, nausea and respiratory problems, in addition to signs of septic shock and classic purpuric non-blanching rash. Specific symptoms include altered mental state, hypocalcaemia, disseminated intravascular coagulation (DIC), haemorrhage, infarction and necrosis of internal organs and bone abnormalities. Consequently, children are left with hearing impairments, sensory disabilities, neurological damage (including epilepsy), chronic organ damage as well as psychiatric and behavioural difficulties. DIC can cause occlusion of blood vessels and microthrombi that lead to fasciitis, necrosis of the limbs and truck resulting in widespread scarring and the need for limb and digit amputation.
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