Neisseria meningitidis W135 pneumonia with sepicaemia in a nonogenarian

[Postoperative pulmonary disease associated with haemophilus influenzae and neisseria meningitidis in a diabetic child]

Haemophilus influenzae is a saprophyte that colonizes the nasopharynx in nearly two thirds of children and adults. Neisseria meningitidis is a strict human bacterium which lives in the nasopharynx. It can cause benign nasopharyngitis or asymptomatic colonization. We report the case of a diabetic child with postoperative pneumonia associated with Haemophilus influenzae and Neisseria meningitidis. A 3-year old diabetic patient admitted to the Department of Cardiac Surgery due to delayed surgical treatment. The postoperative course was marked by a worsening of respiratory status caused by abundant secretions requiring patient admission to the intensive care unit. An assessment for the detection of infections was performed, including protected distal sampling which revealed the association of Neisseria meningitidis with Haemophilus influenzae. This case study allowed us to highlight bacterial associations in certain high-risk situations. Each of these two species is responsible for various infections. However their presence in the same infected site is rare.

Meningococcal pneumonia

Neisseria meningitidis remains the most important cause of bacterial meningitis worldwide, particularly in children and young adults. The second most common and a potentially severe end-organ manifestation of invasive meningococcal disease (excluding systemic sepsis) is meningococcal pneumonia. It occurs in between 5% and 15% of all patients with invasive meningococcal disease and is thus the second most common non-systemic end-organ manifestation. To establish the diagnosis requires a high level of clinical awareness - the incidence is therefore very likely underreported and underestimated. This review of 344 meningococcal pneumonia cases reported in the Americas, Europe, Australia, and Asia between 1906 and 2015 presents risk factors, pathogenesis, clinical manifestations, diagnostic approaches, treatment, and prognosis of meningococcal pneumonia.

[Extra-meningeal meningococcal infection: report of 14 cases]

INTRODUCTION AND METHOD

Fifty-five patients (17 adults, 38 children) with meningococcal infection were admitted between 1986 and 2002 in a university hospital (500 beds). Fourteen of them (nine adults, five children) presented with an extra-meningeal infection. We compared adults and children presentations.

RESULTS

All adults had immunodeficiency. Septic locations were various (three bacteriemia, four pneumoniae, one infected ascitis, one cutaneous abscess). All patients received amoxicillin or third generation cephalosporin. Hospitalisation was prolonged (mean: 47 days). Seven patients required intensive care unit admission, and two of them died. All children (all were less than 36-month-old) presented with fever. Only one was immunodeficient (infected by human immunodeficiency virus). Neisseria meningitidis grew from blood in four, and in the throat for the remaining one. Hospitalisation was of short duration (mean: 4 days) and none of the children required intensive care unit. All the children recovered rapidly with antibiotics.

CONCLUSION

Outcome of extra-meningeal infection with N. meningitidis is different in adults and children. Adults present with immunodeficiency, infection is severe and patients present with various clinical features; children have a more homogeneous clinical presentation (fever) and outcome is excellent.

Meningococcal pneumonia: characterization and review of cases seen over the past 25 years

Fifty-eight cases of meningococcal pneumonia were included in this review. Fifty cases previously described in the literature from 1974 through 1998 and 8 new cases were included in this series. The median age of patients was 57.5 years, and pleuritic chest pain was described in 21 (53.9%) of 39 cases. Blood cultures were positive in 42 (79.3%) of 53 cases for which results were mentioned. Despite the presence of bacteremia, patients did not develop the syndrome of meningococcemia with its associated complications. Serogroup Y meningococci were most commonly recovered and accounted for 44.2% of identified isolates. Therapy has dramatically changed over the past 25 years; prior to 1991, penicillin antibiotics were most often used. Since 1991, 12 (80%) of 15 patients received cephalosporin antibiotics. Only 5 (8.62%) of 58 patients died. Secondary cases of meningococcal infections following exposure to patients with meningococcal pneumonia were noted in 2 instances.