Primary meningococcal conjunctivitis: Summary of evidence for the clinical and public health management of cases and close contacts.

BACKGROUND: Neisseria meningitidis is a rare cause of acute bacterial conjunctivitis but can progress to invasive meningococcal disease (IMD) in the case and their close contacts. There is, however, a lack of consensus on the clinical and public health management of primary meningococcal conjunctivitis (PMC). METHODS: We searched Ovid MEDLINE via PubMed, EMBASE and NHS evidence (up to June 2019) for all publications relating to meningococcal conjunctivitis to provide an evidence-base for developing guidelines for the management of PMC cases and their close contacts. RESULTS: The review identified a 10-29% risk of IMD among PMC cases within two days of onset of eye infection (range: 3 h to 4 days). In one study, the risk of IMD in PMC cases treated with systemic antibiotics was 19 times lower than topical antibiotics alone (p = 0.001). IMD among close contacts of PMC cases is uncommon but potentially fatal. Whether meningococcal vaccination for PMC cases or close contacts provides any additional benefit is unclear. CONCLUSIONS: Systemic antibiotic treatment significantly reduces the risk of invasive disease in PMC cases, while antibiotic chemoprophylaxis for close contacts will reduce their risk of secondary IMD. These findings need to be highlighted in relevant clinical and public health guidelines.

[Meningococcal Septicemia Revealing Multiple Myeloma: A Case Report].

Meningococcal infection is among the most devastating diseases. It is rarely seen in Japan. However, several environmental and host factors have been associated with increased risks of Neisseria meningitidis infection. We present a case of invasive N. meningitidis infection that revealed the presence of multiple myeloma. A 55-year-old Japanese man was admitted with fever and altered consciousness. He was sent to the intensive care unit for septic shock and disseminated intravascular coagulation. In addition to standard septic shock and multiple organ failure treatment, polymyxin-B immobilized column direct hemoperfusion was performed. His blood culture was positive for N. meningitidis. The patient gradually improved and was discharged on day 35. We evaluated the risk factors for the development of meningococcal infection. A laboratory examination showed that the patient was negative for human immunodeficiency virus antibody and had a normal total complement function. However, his serum immunoglobulin G level was high, and serum and urine protein electrophoresis detected a monoclonal gammopathy. A bone marrow examination led to the diagnosis of multiple myeloma. Because N. meningitidis bacteria spreads between individuals in close contact through the exchange of oral secretions, droplet precautions and antimicrobial chemoprophylaxis (ciprofloxacin, 500 mg) were implemented to prevent the spread of the meningococcal infection. Sporadic meningococcal infection warrants an evaluation for immunodeficiency and the prevention of secondary infection.

[Primary meningococcal arthritis in pediatrics. Report of nine cases]. / Artritis meningocócica primaria en pediatría. Presentación de nueve casos.

Primary meningococcal arthritis is an extremely uncommon type of invasive meningococcal disease, with an incidence of 1.5- 1.8% of all paediatric cases of pyogenic arthritis. It is defined as the presence of acute septic arthritis without association with meningitis or the classic meningococcaemia, and isolation of Neisseria meningitidis in synovial fluid and/or blood culture. Typically monoarticular, mostly affects large joints. Prognosis is excellent with appropriated treatment. The aim of this study is to report 9 cases of primary meningococcal arthritis, evaluated at Hospital de Niños "Dr. R. Gutiérrez" in a period of 3 years, and to discuss clinical and epidemiologic issues.

Primary meningococcal polyarthritis in a young man.

We report a rare occurrence of primary meningococcal polyarthritis in a 19-year-old man. The fluid in the elbow joint showed Gram-negative diplococci but the culture was sterile. The diagnosis was confirmed by polymerase chain reaction targeting crgA gene of Neisseria meningitidis.

Meningococcal infections in hospitalised patients in Pretoria.

We report on 13 patients diagnosed with meningococcal infections in patients attending state-owned hospitals serving an indigent population in Pretoria in 2009. The case fatality rate was 27%. Ceftriaxone was the main antibiotic (9 out of 13 patients) for therapy. Five isolates (39%) were serogroup B and 4 (31%) serogroup W135. Most isolates (12/13) were fully susceptible to penicillin (MIC range 0.016 - 0.047 µg/ml). A single isolate was intermediately resistant to penicillin (MIC, 0.125 µg/ml) while all isolates were uniformly susceptible to ceftriaxone, ciprofloxacin and rifampicin. This pattern reveals a shift in serogroups with an increase of serogroup B disease in the Pretoria region, and the need for ongoing monitoring of antimicrobial susceptibility profiles and the value of ceftriaxone for favourable therapeutic outcome.

Penicillin-resistant Neisseria meningitidis bacteraemia, Kimberley region, March 2010.

A 4-year-old fully immunised male presented to a regional hospital in the West Kimberley with fever and lethargy. Blood cultures yielded serogroup B Neisseria meningitidis, resistant to benzylpenicillin (minimum inhibitory concentration (MIC) 1.0 mg/L). The patient was treated with intravenous ceftriaxone and made a complete recovery. Although invasive N. meningitidis isolates with reduced penicillin susceptibility are not uncommon in Australia, this is the first report of a benzylpenicillin-resistant isolate (MIC > 0.5 mg/L) causing invasive disease. As benzylpenicillin is currently recommended as first line empiric and definitive therapy for invasive meningococcal disease, the emergence of penicillin-resistant N. meningitidis disease is of concern and emphasises the importance of ongoing surveillance for antimicrobial resistance.

Disseminated intravascular coagulation, meningococcal infection, and ischemic changes affecting the lower extremities: a case study.

A middle-aged woman presented from an outside hospital with a diagnosis of Neisseria meningitidis and meningococcemia. A nonpalpable purpuric skin rash evolved into multiple wounds, with gradual necrosis of bilateral lower and upper extremities. Throughout the course of hospitalization, the patient developed ventricular tachycardia, normocytic anemia, thrombocytosis, Clostridium difficile infection, depression, and transient right eye blindness. The finding of decreased CH50 in the complement cascade was considered as the potential cause of the meningococcemia. The subsequent ischemia and necrosis of extremities were attributed to the systemic effect and trauma ensuing from N. meningitidis.

[Purulent pericarditis in a patient with knee pain]. / Een purulente pericarditis bij een pijnlijke knie.

A 40-year-old man with pain in his left, swollen knee that persisted for 6 weeks presented with chest pain, dyspnoea and subfebrile temperature. The pain worsened during inspiration and was relieved by sitting up straight. The electrocardiogram showed pericarditis. The patient was treated with high-dose carbasalate calcium. Initially, echocardiography revealed a 2-cm pericardial effusion with no signs of influx inhibition. Blood cultures were positive for Neisseria meningitidis, and treatment was expanded to include antibiotics. Based on a deterioration in patient condition and the tamponade image, pericardiocentesis was performed. Repeated transoesophageal echocardiography showed insufficient drainage of the purulent pericardial effusion. Pericardiectomy was then performed. The patient was doing very well, 3 years after this. If left untreated, the mortality rate for purulent pericarditis approaches 100%. It is therefore important to diagnose at an early stage so that treatment with antibiotics and surgery, which can reduce mortality considerably, can be performed.

Acute urethritis and arthritis-dermatitis syndrome due to Neisseria meningitidis.

Acute urethritis and arthritis-dermatitis syndrome after sexual contact are often assumed to be caused by Neisseria gonorrhoeae. We report a case of arthritis-dermatitis syndrome in a 32-year-old man who presented with generalized maculopapular and petechial skin lesions and polyarthritis. Acute urethritis developed 1 week after oro-genital sexual contact with a sex worker about 3 weeks before admission. No pathogen was found on smear of urethral discharge and skin lesions, but Gram-negative diplococci were noted in joint fluid, and blood culture yielded N. meningitidis. His condition improved gradually after repeated arthrocentesis and antibiotic therapy with ceftriaxone followed by ciprofloxacin. Oro-genital contact is a transmission route for N. meningitidis infection manifesting as acute urethritis and arthritis-dermatitis syndrome.

Pronóstico en niños con enfermedad meningocócica / Prognosis in children with meningoccocal disease

Entre el 1 de enero de 1987 y el 31 de diciembre de 1992 en forma retrospectiva y prospectivamente desde el 1 de enero de 1993 al 31 de julio de 1994, se reunieron antecedentes clínicos y de laboratorio de 67 niños que sufrieron enfermedad meningocócica en Antofagasta, con el propósito de probar el sistema de calificación de Stiehm y Damrosch y otros factores como predictores de la evolución de la enfermedad. Cada factor (púrpura de menos de 12 horas de evolución previo al ingreso; choque; ausencia de meningitis; menos de 10 000 glóbulos blancos por mm3 de sangre; VHS igual o menor a 1o mmHg, mostró asociación con mayor riesgo de fallecer y también el purpura fulminans y el compromiso de conciencia. La letalidad de la enfermedad fue mayor a 75 por ciento en los pacientes con tres o más de los cinco factores de riesgo del criterio de Stiehm y Damrosch. Se requieren estudios prospectivos y de análisis multivariados más completos para definir mejor las interrelaciones de los factores estudiados individualmente

[The metal content of the blood in patients with bacterial meningoencephalitis]. / Soderzhanie nekotorykh metallov v krovi bol'nykh bakterial'nymi meningoéntsefalitami.

A study is presented of the quantitative content of blood metals in 60 patients depending on the duration and severity of bacterial meningoencephalitis. It was established that examination of the concentration of macro- and microelements in their dynamics reflects the state of mineral blood homeostasis and can be used as supplementary criterion in the diagnosis of bacterial meningoencephalitis.

Meningococcal pericarditis in the absence of meningitis.

A 16 year-old female presented with cardiac tamponade due to purulent meningococcal pericarditis without concomitant meningitis or meningococcaemia. She recovered after aspiration of the pericardial effusion and administration of a high dose of benzylpenicillin via a continuous infusion.