Neisseria meningitidis Serogroup C Causing Primary Arthritis in a Child

Abstract

Introduction: Neisseria meningitidis (N. meningitidis) is associated with severe invasive infections such as meningitis and fulminant septicemia. Septic arthritis due to N. meningitidis is rare and bone infections have been reported exceptionally. We report the case of a 1-year old girl who presented with a painful, swollen right knee, accompanied by fever and agitation. Arthrocentesis of the right knee, while patient was under anesthesia, yielded grossly purulent fluid, so we made arthrotomy and drainage. The culture from synovial fluid revealed N. meningitidis, sensitive to Ceftriaxone. The patient received intravenous antibiotherapy with Ceftriaxone. The status of the patient improved after surgical drainage and intravenous antibiotic therapy. She recovered completely after 1 month.Conclusion: This observation illustrates an unusual presentation of invasive meningococcal infection and the early identification of the bacteria, combined with the correct treatment, prevent the complications and even death.

Serogroup Y primary meningococcal arthritis in a child

“…N. meningitidis isolates are characterised serologically based on capsular polysaccharides, with serogroups A, B, C, Y and W accounting for the majority of invasive meningococcal disease (IMD) world‐wide . Meningococcal serogroup Y (MenY) was the causative serogroup in our patient.…”

“…PMA is a rare form of meningococcal disease in which symptoms of an acute septic arthritis develop without features of meningitis or the purpura and haemodynamic instability of meningococcaemia . It is a rare entity, with less than 50 cases described in the combined adult and paediatric literature world‐wide . Features that have been correlated with PMA include a prodrome of upper respiratory symptoms (50–60%), an erythematous maculopapular rash (50%), monoarticular disease (80%) and a predilection for large joints (89%) .…”

“…It is a rare entity, with less than 50 cases described in the combined adult and paediatric literature world‐wide . Features that have been correlated with PMA include a prodrome of upper respiratory symptoms (50–60%), an erythematous maculopapular rash (50%), monoarticular disease (80%) and a predilection for large joints (89%) . Bacterial invasion of the synovium via blood‐borne infection is the proposed pathogenesis of PMA, and the gold standard of diagnosis is the synovial culture of N. meningitidis .…”

Meningococcal arthritis and myopericarditis: a case report

“…PMA remains a rare diagnosis, with only 46 cases reported up to 2016 [ 14 ]. Presentation of PMA may be very similar to that of other forms of septic arthritis [ 12 ].…”

“…Presentation of PMA may be very similar to that of other forms of septic arthritis [ 12 ]. It is most commonly monoarticular [ 15 ], with the knee the most commonly involved joint [ 12 , 14 , 16 ], but can also be oligoarticular or polyarticular [ 12 , 16 ]. Causative serotypes are group B, 30–38%; group C, 33–36%; and group W-135, 13–29% [ 15 , 17 ].…”