Objectives: Children with meningococcal sepsis are highly at risk for fulminant disease, multiple organ failure, and death. Recently, neutrophil extracellular traps levels have been indicated as a marker for severity in different kinds of sepsis. Our aim was to study the role of neutrophil extracellular traposis in meninogococcal sepsis in children. Design: We measured myeloperoxidase-DNA, a marker for neutrophil extracellular traps, in serum of meningococcal sepsis patients upon admission to PICU, at 24 hours, and at 1 month and studied the association with clinical outcome. Subsequently, we tested whether Neisseria meningitidis, isolated from children with meningococcal sepsis, were able to induce neutrophil extracellular traposis, using confocal microscopy live imaging. Setting: We used enzyme-linked immunosorbent assays to measure myeloperoxidase-DNA in patient serum. We also included inflammatory markers that were previously measured in this group. Patients: We included exclusively children with meningococcal sepsis. Interventions: From each patient, serum was collected for analysis. Measurements and Main Results: Myeloperoxidase-DNA levels at admission (n = 35; median, 0.21 AU/mL; interquartile range, 0.12-0.27) and at 24 hours (n = 39; median, 0.14 AU/mL; interquartile range, 0.09-0.25) were significantly higher than the myeloperoxidase-DNA levels after 1 month (controls: n = 36; median, 0.07 AU/mL; interquartile range, 0.05-0.09; p < 0.001). We did not observe a correlation between myeloperoxidase-DNA levels and mortality, cell-free DNA, or other inflammatory markers. In addition, N. meningitidis are fast and strong inducers of neutrophil extracellular traposis. Conclusions: Children admitted to PICU for meningococcal sepsis have higher neutrophil extracellular traps levels at admission and after 24 hours than controls. Neutrophil extracellular traps levels were not associated with outcome, cell-free DNA, or other inflammatory markers. These neutrophil extracellular traps may be induced by N. meningitidis, since these are strong neutrophil extracellular traposis inducers.

critical care, meningococcal infections, mortality, Neisseria meningitidis, neutrophil extracellular traps, pediatrics
dx.doi.org/10.1097/PCC.0000000000001496, hdl.handle.net/1765/110610
Pediatric Critical Care Medicine
Department of Plastic and Reconstructive Surgery

Hoppenbrouwers, T, Boeddha, N.P, Ekinci, E. (Ebru), Emonts, M, Hazelzet, J.A, Driessen, G.J.A, & de Maat, M.P.M. (2018). Neutrophil Extracellular Traps in Children with Meningococcal Sepsis. Pediatric Critical Care Medicine, 19(6), e286–e291. doi:10.1097/PCC.0000000000001496