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Invasive meningococcal disease without meningitis: a forgotten diagnosis

Authors Walayat S, Hussain N, Malik AH, Vazquez-Melendez E, Aulakh BS, Lynch T

Received 22 October 2017

Accepted for publication 17 January 2018

Published 12 April 2018 Volume 2018:11 Pages 87—90


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas

Saqib Walayat,1 Nooreen Hussain,1 Abdullah H Malik,1 Elsa Vazquez-Melendez,1 Bhagat S Aulakh,2 Teresa Lynch1

1Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA; 2Department of Pulmonary/Critical Care Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA

Abstract: Neisseria meningitidis, a Gram-negative diplococcus, is an uncommon cause of pneumonia. There have been only about 344 cases reported worldwide from 1906 to 2015. To our knowledge, there have been only 3 cases reported in the USA in the past 2 decades. We present a case of a 72-year-old male with a past medical history of severe COPD, obstructive sleep apnea, and stage I lung cancer status post-stereotactic body radiation therapy 1 year ago, who was admitted with a 6-day history of productive cough with yellowish sputum, shortness of breath, extreme myalgias, and fatigue. Chest X-ray revealed an infiltrative process in the left lower lung field and left-sided pleural effusion. Blood cultures grew beta-lactamase-negative N. meningitidis after 24 hours. Our patient was initially treated with broad-spectrum antibiotics, which were later switched to amoxicillin to complete a total of 14 days of antibiotics. Diagnosing meningococcal pneumonia requires a high level of suspicion, as sputum cultures may be falsely positive due to asymptomatic carriage of the organism in the upper respiratory tract in up to 10% of outpatient population. We highlight this case as early recognition and treatment is critical. The case fatality rate for N. meningitidis pneumonia has been reported to be higher compared with meningococcal meningitis.

Keywords: Neisseria meningitidis, pneumonia, invasive meningococcal pneumonia, sepsis

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