1
|
Bobde S, Sohn WY, Bekkat-Berkani R, Banzhoff A, Cavounidis A, Dinleyici EC, Rodriguez WC, Ninis N. The Diverse Spectrum of Invasive Meningococcal Disease in Pediatric and Adolescent Patients: Narrative Review of Cases and Case Series. Infect Dis Ther 2024; 13:251-271. [PMID: 38285269 PMCID: PMC10904702 DOI: 10.1007/s40121-023-00906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a potentially life-threatening disease caused by Neisseria meningitidis infection. We reviewed case reports of IMD from newborns, infants, children, and adolescents, and described the real-life clinical presentations, diagnoses, treatment paradigms, and clinical outcomes. METHODS PubMed and Embase were searched for IMD case reports on patients aged ≤ 19 years published from January 2011 to March 2023 (search terms "Neisseria meningitidis" or "invasive meningococcal disease", and "infant", "children", "paediatric", pediatric", or "adolescent"). RESULTS We identified 97 publications reporting 184 cases of IMD, including 25 cases with a fatal outcome. Most cases were in adolescents aged 13-19 years (34.2%), followed by children aged 1-5 years (27.6%), children aged 6-12 years (17.1%), infants aged 1-12 months (17.1%), and neonates (3.9%). The most common disease-causing serogroups were W (40.2%), B (31.7%), and C (10.4%). Serogroup W was the most common serogroup in adolescents (17.2%), and serogroup B was the most common in the other age groups, including children aged 1-5 years (11.5%). The most common clinical presentations were meningitis (46.6%) and sepsis (36.8%). CONCLUSIONS IMD continues to pose a threat to the health of children and adolescents. While this review was limited to case reports and is not reflective of global epidemiology, adolescents represented the largest group with IMD. Additionally, nearly half of the patients who died were adolescents, emphasizing the importance of monitoring and vaccination in this age group. Different infecting serogroups were predominant in different age groups, highlighting the usefulness of multivalent vaccines to provide the broadest possible protection against IMD. Overall, this review provides useful insights into real-life clinical presentations, treatment paradigms, diagnoses, and clinical outcomes to help clinicians diagnose, treat, and, ultimately, protect patients from this devastating disease.
Collapse
Affiliation(s)
| | - Woo-Yun Sohn
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, USA
| | | | | | | | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Wilfrido Coronell Rodriguez
- Pediatric Infectious Diseases, University of Cartagena, Cartagena, Colombia
- Serena del Mar Hospital, Cartagena, Colombia
| | - Nelly Ninis
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
2
|
Broom M, Best E, Heffernan H, Svensson S, Hansen Hygstedt M, Webb R, Gow N, Holland D, Thomas M, Briggs S. Outcomes of adults with invasive meningococcal disease with reduced penicillin susceptibility in Auckland 2004-2017. Infection 2022; 51:425-432. [PMID: 35982367 DOI: 10.1007/s15010-022-01897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to assess the clinical outcomes of adults with invasive meningococcal disease (IMD) and to compare the outcomes of patients with IMD caused by a penicillin susceptible isolate (minimum inhibitory concentration (MIC) ≤ 0.06 mg/L) with patients with IMD caused by an isolate with reduced penicillin susceptibility (MIC > 0.06 mg/L). We also assessed the outcomes of patients with IMD caused by an isolate with reduced penicillin susceptibility who were treated exclusively with intravenous (IV) benzylpenicillin. METHODS Retrospective study of all culture positive IMD in adult patients (age ≥ 15 years) in the Auckland region from 2004 to 2017. RESULTS One hundred and thirty-nine patients were included; 94 had penicillin susceptible isolates (88 cured, 6 died), and 45 had an isolate with reduced penicillin susceptibility (41 cured, 1 possible relapse, 3 died). The median benzylpenicillin/ceftriaxone treatment duration was 3 days for both groups. There was no difference in the patient outcomes of both groups. Eighteen patients with IMD caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone and were cured. CONCLUSIONS This study provides further support to existing data that has shown that short duration IV beta-lactam treatment is effective for IMD in adults. Only a small number of patients with meningitis caused by an isolate with reduced penicillin susceptibility received benzylpenicillin alone, limiting its evaluation. For Neisseria meningitidis meningitis, we recommend ceftriaxone as empiric treatment and as definitive treatment when this is caused by an isolate with reduced penicillin susceptibility.
Collapse
Affiliation(s)
- Matthew Broom
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand. .,North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand.
| | - Emma Best
- Starship Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,Department of Paediatrics, University of Auckland, Level 12, Support Building Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Helen Heffernan
- The Institute of Environmental Science and Research, 34 Kenepuru Drive, Kenepuru, Porirua, New Zealand
| | - Sara Svensson
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,University of Gothenburg, 405 30, Gothenburg, Sweden.,Norra Ӓlvsborgs Lӓnssjukhus, Lӓrketorpsvӓgen, 461 73, Trollhӓttan, Sweden
| | - Maria Hansen Hygstedt
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,University of Gothenburg, 405 30, Gothenburg, Sweden.,, Ӧgonkliniken, Lansmansgatan 20, 431 30, Molndal, Sweden
| | - Rachel Webb
- Middlemore Hospital Kidz First Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand
| | - Nick Gow
- North Shore Hospital Infectious Diseases Department, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand
| | - David Holland
- Middlemore Hospital Infectious Diseases Department, Counties Manukau District Health Board, 100 Hospital Road, Middlemore, Auckland, 2025, New Zealand
| | - Mark Thomas
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand.,Department of Molecular Medicine, University of Auckland, Grafton Campus, Grafton, Auckland, 1023, New Zealand
| | - Simon Briggs
- Auckland City Hospital Infectious Diseases Department, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| |
Collapse
|
3
|
Gyamfi-Brobbey G, Clark SA, Campbell H, Lekshmi A, Ribeiro S, Walker A, Mensah A, Willerton L, Walsh L, Lucidarme J, Bai X, Ladhani SN, Ahmed S, Walton T, Borrow R. An analysis of Neisseria meningitidis strains causing meningococcal septic arthritis in England, and Wales: 2010-2020. J Infect 2022; 85:390-396. [PMID: 35914608 DOI: 10.1016/j.jinf.2022.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To analyse clinical meningococcal strains associated with meningococcal septic arthritis cases in England and Wales, and to identify associations between patient age, the synovial joint affected and strain characteristics. METHODS IMD cases confirmed by the Meningococcal Reference Unit (UK Health Security Agency) between January 2010 and December 2020 were included in the analysis. Septic arthritis cases were defined as those featuring detection and/or isolation of N. meningitidis from an articular site. Capsular grouping was performed by serology on clinical isolates and/or real-time PCR on clinical samples. RESULTS We identified 162 cases of meningococcal septic arthritis, representing 2% of all invasive meningococcal disease cases during the study period. The knee and the hip were the most commonly affected joints, with the former significantly more frequent in adults and the latter seen more commonly in children and adolescents. Group B strains were between 2 and 6 times less likely to cause septic arthritis in relation to groups W, C and Y strains. CONCLUSIONS Meningococcal septic arthritis remains a rare manifestation of invasive meningococcal disease. Strain and age associations identified in this study remain unexplained. Future analyses including clinical case information may help to explain these interesting findings.
Collapse
Affiliation(s)
- George Gyamfi-Brobbey
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Stephen A Clark
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK.
| | - Helen Campbell
- Immunisation and Countermeasures Division, UK Health Security Agency, 61 Colindale Avenue, London, UK
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, UK Health Security Agency, 61 Colindale Avenue, London, UK
| | - Andrew Walker
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Anna Mensah
- Immunisation and Countermeasures Division, UK Health Security Agency, 61 Colindale Avenue, London, UK
| | - Laura Willerton
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Lloyd Walsh
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Xilian Bai
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, 61 Colindale Avenue, London, UK
| | - Saad Ahmed
- Colchester Hospital, East Suffolk and North Essex NHS Trust, Turner Road, Mile End, Colchester, UK
| | - Tom Walton
- Colchester Hospital, East Suffolk and North Essex NHS Trust, Turner Road, Mile End, Colchester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK; Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| |
Collapse
|
4
|
Guedes S, Bertrand-Gerentes I, Evans K, Coste F, Oster P. Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature. BMC Public Health 2022; 22:380. [PMID: 35197024 PMCID: PMC8864456 DOI: 10.1186/s12889-022-12795-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD. METHODS A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information. RESULTS There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults. CONCLUSIONS The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.
Collapse
Affiliation(s)
- Sandra Guedes
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | | | | | - Florence Coste
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Philipp Oster
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
| |
Collapse
|
5
|
Anderson AJ, Bowen AC, Hazelton B, O'Brien M, Blyth CC, Campbell AJ. Meningococcal serotype W septic arthritis: Case series in children. J Paediatr Child Health 2021; 57:1990-1994. [PMID: 33650287 DOI: 10.1111/jpc.15385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Aleisha J Anderson
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Briony Hazelton
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Matthew O'Brien
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
6
|
Cimé-Aké E, Carranza-Enríquez F, Hurtado-Arias JJ, Muñoz-Castañeda WRA, Medina-Fonseca B, Barrera-Vargas A, Lizardo-Thiebaud MJ, Saeb-Lima M, Merayo-Chalico J. Primary meningococcal septic arthritis associated with joint calcium oxalate crystals: A case report and review of the literature. Mod Rheumatol Case Rep 2021; 6:296-300. [PMID: 34850098 DOI: 10.1093/mrcr/rxab049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.
Collapse
Affiliation(s)
- Erik Cimé-Aké
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fabián Carranza-Enríquez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Joel Hurtado-Arias
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Wallace Rafael A Muñoz-Castañeda
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Benjamín Medina-Fonseca
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María J Lizardo-Thiebaud
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marcela Saeb-Lima
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
7
|
Abd El-Wahab EW, Farrag T, Metwally M. A clinical rule for the prediction of meningitis in HIV patients in the era of combination antiretroviral therapy. Trans R Soc Trop Med Hyg 2021; 114:264-275. [PMID: 31768553 DOI: 10.1093/trstmh/trz107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The diagnosis of meningitis in HIV patients is challenging due to altered immune responses. Diagnostic scoring systems were recently proposed for use in research settings to help prompt and easy differential diagnosis. The objective of this study was to create a clinical prediction rule (CPR) for meningitis in HIV-infected patients and to address the enigma of differentiating bacterial (BM), TB (TBM) and cryptococcal (CCM) meningitis based on clinical features alone, which may be enhanced by easy-to-obtain laboratory testing. METHODS We retrospectively enrolled 352 HIV patients presenting with neurological manifestations suggesting meningitis over the last 18 y (2000-2018). Relevant clinical and laboratory information were retrieved from inpatient records. The features independently predicting meningitis or its different types in microbiologically proven meningitis cases were modelled by multivariate logistic regression to create a CPR in an exploratory data set. The performance of the meningitis diagnostic score was assessed and validated in a subset of retrospective data. RESULTS AIDS clinical stage, injecting drug use, jaundice and cryptococcal antigen seropositivity were equally important as classic meningitic symptoms in predicting meningitis. Arthralgia and elevated cerebrospinal fluid Lactate dehydrogenase (LDH) were strong predictors of BM. Patients with cryptococcal antigenemia had 25 times the probability of having CCM, whereas neurological deficits were highly suggestive of TBM. CONCLUSION The proposed CPRs have good diagnostic potential and would support decision-making in resource-poor settings.
Collapse
Affiliation(s)
- Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, 165 El Horreya Road, 21561 Alexandria, Egypt
| | - Talaat Farrag
- Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, 21568 Alexandria, Egypt.,Fellow of the Tropical Health Department, High Institute of Public Health, Alexandria University, 165 El Horreya Road, 21561 Alexandria, Egypt
| | - Mohammed Metwally
- Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, 21568 Alexandria, Egypt
| |
Collapse
|
8
|
Ducatez N, Chancel M, Douadi Y, Dayen C, Suguenot R, Lecuyer E, Brihaye B, Bentayeb H. Primary meningococcal arthritis in a COVID-19 18-year-old man: a case report and review of the literature. BMC Infect Dis 2021; 21:499. [PMID: 34051739 PMCID: PMC8164068 DOI: 10.1186/s12879-021-06211-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with various complications. PMA (primary meningococcal arthritis) is a rare meningococcus-associated disease causing arthritis of the knee usually, without any signs of invasive meningococcal disease. No case of PMA in a COVID-19 (coronavirus disease, 2019) patient has yet been described. PMA mainly strikes young adults. PMA is not associated with any immunocompromising condition. It has a better outcome than usual septic arthritis CASE PRESENTATION: Herein, we report an 18-year-old man diagnosed with COVID-19, later admitted with persistent fever, right knee arthralgia and maculopapular rash. Due to family history, psoriasis and Henoch-Schönlein purpura were hypothesized and ruled out. Finally, synovial fluid culture confirmed Neisseria meningitidis serogroup B arthritis without any other symptoms of invasive meningococcal disease. Healing was achieved quickly with surgery and antibiotics. We concluded in a PMA. CONCLUSION We describe here the first primary meningococcal arthritis in a COVID-19 patient and we hope to shine a light on this rare but serious complication.
Collapse
Affiliation(s)
- Norman Ducatez
- Pneumology and Infectious Diseases department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France.
| | - Marine Chancel
- Internal Medicine department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - Youcef Douadi
- Pneumology and Infectious Diseases department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - Charles Dayen
- Pneumology and Infectious Diseases department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - Rémi Suguenot
- Pneumology and Infectious Diseases department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - Emmanuelle Lecuyer
- Pneumology and Infectious Diseases department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - Benoit Brihaye
- Internal Medicine department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| | - Houcine Bentayeb
- Pneumology and Infectious Diseases department, Saint-Quentin hospital, 1 avenue Michel de l'hospital, 02100, Saint-Quentin, France
| |
Collapse
|
9
|
Ducours M, El-Hout S, Desclaux A, Dutronc H, Deltombe T, Fauthoux T, Vercruysse F, Kostine M, Cazanave C. Short duration antibiotic therapy for native joint arthritis caused by Neisseria infection? Ann Rheum Dis 2020; 81:e230. [PMID: 32988840 DOI: 10.1136/annrheumdis-2020-218835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Maïlys Ducours
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Samar El-Hout
- Rheumatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Arnaud Desclaux
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Hervé Dutronc
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Thylbert Deltombe
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Thomas Fauthoux
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France.,Rheumatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | | | - Marie Kostine
- Rheumatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France .,INRAE, IHMC, USC EA 3671, Univ. Bordeaux, F-33000, Bordeaux, France
| |
Collapse
|
10
|
Abstract
INTRODUCTION Meningococcal disease caused by Neisseria meningitidis has a high case fatality rate. Of 12 distinct serogroups, A, B, C, W-135 (W) and Y cause the majority of infections. The meningococcal disease burden and epidemiology in India are not reliably known. Hence, we performed a narrative review with a systematically conducted search to summarize information on meningococcal disease burden and epidemiology and vaccination recommendations for meningococcal disease in India. METHODS A search of Medline and Embase databases was undertaken to identify relevant publications published in the last 25 years. RESULTS Results from 32 original publications, 11 of which were case reports, suggest a significant burden of meningococcal disease and related complications. Meningococcal disease is increasingly reported among adolescents and adults, and large outbreaks have been reported in this population. Meningococcal disease in India is caused almost exclusively by serogroup A; serogroups B, C, W and Y have also been documented. Meningococcal disease burden data remain unreliable because of limited disease surveillance, insufficient laboratory capacity, misdiagnosis and prevalence of extensive antibiotic use in India. Lack of access to healthcare also increases under-reporting, thus bringing the reliability of the data into question. Conjugate meningococcal vaccines are being used for disease prevention by national governments and immunization programs globally. In India, meningococcal vaccination is recommended only for certain high-risk groups, during outbreaks and for international travelers such as Hajj pilgrims and students pursuing studies abroad. CONCLUSION Meningococcal disease is prevalent in India but remains grossly underestimated and under-reported. Available literature largely presents outbreak data related to serogroup A disease; however, non-A serogroup disease cases have been reported. Reliable epidemiologic data are urgently needed to inform the true burden of endemic disease. Further research into the significance of meningococcal disease burden can be used to improve public health policy in India. Fig. 1 Plain language summary.
Collapse
|
11
|
Damonti L, Marschall J, Lo Priore E, Buetti N. Disseminated meningococcal infection, early petechiae. Int J Infect Dis 2020; 93:231-232. [PMID: 32045696 DOI: 10.1016/j.ijid.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Elia Lo Priore
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; INSERM IAME, U1137, Team DesCID, Paris, France
| |
Collapse
|
12
|
Wang AA, Linson EA. Septic arthritis in a previously healthy man with pan-negative infectious and rheumatologic work-up. BMJ Case Rep 2020; 13:13/2/e231823. [PMID: 32019756 DOI: 10.1136/bcr-2019-231823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neisseria gonorrhoeae is the causative organism in 0.6%-1.2% of septic arthritis cases in North America and Europe, and classically presents as migratory polyarthralgias and tenosynovitis, with later development of septic oligoarthritis. In men, urine gonorrhoea nucleic amplification testing (NAAT) is the preferred diagnostic test, as its sensitivity surpasses that of joint and blood culture in disseminated infections. We present a case of a previously healthy man who presented with septic arthritis of the wrist. He denied any sexual activity in the previous year. Urine gonorrhoea NAAT and cultures were negative. However, N. gonorrhoeae was later identified via 16s PCR of the patient's synovial fluid, leading to a delayed diagnosis of gonococcal arthritis. In patients with septic arthritis, gonococcal infection should remain on the differential despite reported sexual history and negative urine NAAT. Clinicians should continue to follow cultures and provide antibiotic coverage until a causative organism is identified.
Collapse
Affiliation(s)
- Ann Andee Wang
- Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elyse Anna Linson
- Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| |
Collapse
|
13
|
Fulminant Neisseria meningitidis septicaemia with purpura fulminans requiring limb amputation. IDCases 2019; 19:e00673. [PMID: 31879595 PMCID: PMC6920294 DOI: 10.1016/j.idcr.2019.e00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/17/2019] [Accepted: 11/17/2019] [Indexed: 12/05/2022] Open
Abstract
Despite the isolation of Neisseria meningitidis over 200 years ago, meningococcal disease remains a feared cause of bacterial sepsis, with significant morbidity and mortality, despite prompt antibiotic use and modern critical care support. Neisseria meningitides is a Gram-negative encapsulated diplococcus, which exists only in the human host (Kvalsvig and Unsworth, 2003). The bacterium can cause life-threatening septic shock and coagulopathy, which may rapidly manifest within a matter of hours from preceding mild symptoms (Kvalsvig and Unsworth, 2003). Whilst N. meningitidis is recognised as a common commensal organism in the nasopharynx, associated with asymptomatic carriage in up to 10 %, manifestation of life-threatening disease is rare (Rappuoli and Pizza, 2015). We report the case of 31-year-old male presenting with devastating meningococcal septicaemia with disseminated intravascular coagulopathy (DIC) and purpura fulminans, requiring surgical debridement and a right above-knee amputation for sepsis-driven skin necrosis. The patient suffered extensive tissue loss secondary to a type 3 immune hypersensitivity reaction involving immune-complex mediated inflammation and tissue necrosis. Due to a strong immune component driving the patient’s failure to convalesce pulsed intravenous methylprednisolone was used alongside antimicrobial therapy. The use of steroids was associated with fever subsidence and significant clinical improvement, highlighting the benefit of corticosteroid use in immune-complex mediated pathology.
Collapse
|
14
|
Campbell H, Andrews N, Parikh S, Ribeiro S, Gray S, Lucidarme J, Ramsay ME, Borrow R, Ladhani SN. Variable clinical presentation by the main capsular groups causing invasive meningococcal disease in England. J Infect 2019; 80:182-189. [PMID: 31715210 DOI: 10.1016/j.jinf.2019.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Invasive meningococcal disease (IMD) typically presents as meningitis, septicaemia or both. Atypical clinical presentations are rare but well-described. We aimed to assess the relationship between meningococcal capsular group, age, clinical presentation, diagnosis and outcome among IMD cases diagnosed in England during 2014. METHODS Public Health England conducts enhanced national surveillance of IMD in England. Clinical data for laboratory-confirmed MenB, MenW and MenY cases in ≥5 year-olds were used to classify presenting symptoms, diagnosis and outcomes. Multivariable logistic regression was used to assess independent associations between meningococcal capsular group, clinical presentation, gender, age and death. RESULTS In 2014, there were 340 laboratory-confirmed IMD cases caused by MenB (n = 179), MenW (n = 95) and MenY (n = 66). Clinical presentation with meningitis alone was more prevalent among MenB cases (28%) and among 15-24 year-olds (20%), whilst bacteraemic pneumonia was most prevalent among MenY cases (26%) and among ≥65 year-olds (24%). Gastrointestinal symptoms were recorded preceding or during presentation in 15% (40/269) cases with available information, including 5% (7/140) MenB, 17% (8/47) MenY and 30% (25/82) MenW cases. Upper respiratory tract symptoms were reported in 16% (22/141) MenB, 23% (11/47) MenY and 31% (26/84) MenW cases. Increasing age was also independently associated with bacteraemic meningococcal pneumonia, with no cases among 5-14 year-olds compared to 24% in ≥65 year-olds. Case fatality rates increased with age but no significant associations with death were identified. CONCLUSIONS Healthcare professionals should be aware of the atypical clinical presentations associated with the less prevalent meningococcal capsular groups in different age-groups.
Collapse
Affiliation(s)
- Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London NW9 5EQ, UK
| | - Sydel Parikh
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Steve Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
| |
Collapse
|