Atypical presentation of invasive meningococcal disease caused by serogroup W meningococci

Abstract

Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.

Keywords: Acute gastrointestinal symptoms; invasive meningococcal disease; pneumonia; septic arthritis; serogroup W.

Fig. 1.

Flow diagram of the study.

Fig. 2.

Serotypes responsible for all IMD cases or cases with abdominal presentation in France, 1991–2016. Percentages are provided along with the 95% CIs (*P < 0.01, **P < 0.001, ***P < 0.0001). Adapted with permission from Guiddir et al., Clinical Infectious Diseases 2018; 67: 1220-1227 [3].