228 MED ARH 2010; 64(4) • ORIGINAL PAPER Dexamethasone as adjuvant therapy in the treatment of invasive meningococcal diseases ORIGINAL PAPER Dexamethasone as adjuvant therapy in the treatment of invasive meningococcal diseases Ilir Tolaj 1, 2 , Shemsedin Dreshaj 1, 2 , Emine Qehaja 1, 2 , Jasmina Tolaj 2 , Teuta Doda-Ejupi 1, 2 , Murat Mehmeti 1 Department of Infectious Diseases, University Clinical Center of Kosovo, Prishtina, Kosova 1 Faculty of Medicine, University of Prishtina, Prishtina, Kosova 2 P urpose: With this study we want to evaluate the role of dexamethasone adjuvant treatment in different clinical forms of invasive meningococ- cal diseases. Work Methods: is was a randomized, open label trial that was conducted in 147 individuals with meningococcal sepsis. All of the cases have been divided in two groups: (1) Cases with meningococcal disease and CNS infection, and (2) Cases with meningococcal disease and no affec- tion of the CNS. Cases from both groups were treated with dexamethasone, 0.15 mg/kg, every 6 h, for 4(four) days, as adjuvant therapy. Cases which were not treated with dexamethasone were used as control group. Work Results: From overall number of cases, in 130 of them, the meningococcal disease was accompanied with meningitis; in other 17 cases only signs of sepsis were present. In both clinical forms, the dexamethasone was used in 92 cases. e higher mortality rate is registered among the cases without meningitis, 17.65%, compared with 6.92% which is registered among cases with meningitis. e overall mortality rate among all cases was 8.2%. e significant difference was recorded only on CSF sugar level between two groups (treated or not with dexamethasone) on the day 1-4 of the hospital- ization. Discussion: Our epidemiological data are in correlation with data from other epidemiological studies. Most of the cases 69.4%, were more than 12 hours sick at home before the hospitalization, 7.5 % of cases were hospitalized within 12 hours from the onset of the diseases, while 23.1% of cases data are missing. is is in correlation with similar data from other studies. Conclusion: Dexamethasone has a limited effect on outcome of the invasive meningococcal disease. Dexamethasone had some effect only during the days of administration in cases with clinical form of sepsis with meningitis, by normalizing the values of CSF sugar earlier. Key words: dexamethasone, meningococcal sepsis, therapy Corresponding author: Ilir Tolaj, MD, PhD, University Clinical Center of Kosova, Department of Infectious Diseases, Prishtina tel +37744177617. E-mail:drtolaj@yahoo.com 1. INTRODUCTION Neisseria meningitidis, an encapsu- lated, oxidase positive, Gram-negative coccus, is solely a human pathogen [1,2,3]. It is an etiological cause of meningococ- cal disease. Meningococci may cause dif- ferent clinical syndromes, but in clinical practice, meningitis or sepsis, or more of- ten in combination of both, is the most life threatening clinical conditions (1). Meningococcal disease remains an important health problem that occurs worldwide as endemic infection. e incidence of meningococcal disease varies from 1-3/100.000 in most indus- trialized nations to 10-25/100.000 in some third-world countries, [1]. Dur- ing epidemics peaks, the disease inci- dence may approach 1000/100.000 in- habitants, (1,2). At least four conditions have to be met before the invasive disease can oc- cur: exposure to a pathogenic strain, colonization of the naso-oropharyngeal mucosa, passage through that mucosa, and survival of the meningococcus in the bloodstream (3,4). Once viable me- ningococci have reached the blood- stream, different manifestation can de- velop (1,2,5). e most common pre- sentation in Europe is with features of both meningitis and septicemia (around 60%). One-fifth presents with features of meningitis alone, and one –quarter present with septicemia alone (2). Antibiotics do not halt the menin- geal inflammatory processes immedi- ately. Some studies show even a tran- sient worsening of the inflammation after antibiotic administration, possi- bly due to the enhancement of endo- toxin release. In sepsis the antibiotic-in- duced endotoxin release has never been observed (1). A possible explanation for this discrepancy is that the clearance of endotoxin and/or the regulation of the production of cytokines in the CSF dif- fer from that in the bloodstream. In population based studies, includ- ing all ages, the overall mortality for meningococcal disease was found to be around 7%. e reported mortality of children who were admitted to in- tensive care with meningococcal dis- ease varies between 14.5% and 35% (4). e mortality of meningococcal septi- cemia is consistently higher than the mortality from meningococcal menin- gitis. When features of both septicemia and meningitis are present, the mortal- ity rate is intermediate (2). Aggressively early treatment of me- ningococcal disease can reduce mor- tality. Routine use of steroids remains