Primary Meningococcal Pneumonia Without Meningitis

Abstract

INTRODUCTION: We represent a case of Primary Neisseria Meningococcal pneumonia,a rare cause of pneumonia in 34 y/o diabetic male without meningitis. CASE PRESENTATION: 34 y/o Male with PMHx of DM presented with 4 days of productive cough with yellow sputum, fever and pleuritic chest pain along with abdominal pain, nausea, vomiting found to be in DKA(PH 7.19,AG 26,Glucose 469) with with elevated white count to 11.6 and 30 band cells. Chest Xray revealed RUL and LLL consolidation. Blood cultures were drawn and patient was admitted to Medicine stepdown ICU for the treatment of DKA and CAP which was started with ceftrixone and clarithromycin. Blood culture grew out group Y Neisseria meningitidis. Subsequent blood cultures were negative. Patient was also ruled out for TB and HIV. Clinical status improved over next 5 days and was discharged home with 2 more days of PO cefpodoxime. DISCUSSION: Historical background: Meningococcal Pneumonia caused by N. meningitidis has been reported since early 1900s and was associated with the Influenza Pandemic, but it is a rare cause of pneumonia in current day practice. N.meningitidis can be found in 10% of throat cultures in asymptomatic patients. Most available data come from case series report in early 2000 and last case reports published in 2006 and 2009 in English literature. Disease Characteristics: Mean duration before presentation 5.5 days, bimodal age distribution, mean age 57.5 years, association with DM, COPD, HIV, malignancy, steroid use. Commonly Single lobe involvement with RLL being most predominant. Diagnosis based on CXR and blood culture(80%) Serogroup Y is the most common isolate (44%) followed by W-135 (19.2%). Human-to-human transmission is rare. Mortality around 8%. TREATMENT: isolation only required 24 hours after initiation of antibiotics. Cephalosporins aremainstay of treament. Prophylaxis for close contacts with Rifampin or ciprofloxacin or ceftrioxone. Meningococcal vaccines offer some protection. CONCLUSIONS: Neisseria meningitidis is an uncommon cause of pneumonia and clinically indistinguishable from more common forms of pneumonia. Blood cultures are important and if found positive, it is reportable to Department Of Health and close contacts should be treated.