Meningococcal pneumonia, a case report

Abstract

Background: Traditionally, Neisseria meningitidis posed significant morbidity and mortality causing epidemics or sporadic cases of meningitis or septicemia with moribund complications if untreated early. However, it has been observed rarely causing community-acquired pneumonia, without any central nervous system complications. Case Description: A 64 year old gentleman, with underlying diabetes mellitus presented with 1 week history of non-productive cough, fever and lethargy. There was no neck stiffness or headache and the immediate family members denied any altered sensorium or behavioral changes. He was well prior to admission and no recent travelling or Hajj pilgrimage. He was febrile at 38.3 C and fine bibasal crepitations noted on auscultation. Chest radiograph revealed bilateral perihilar haziness. Blood culture grew Neisseria meningitidis, identified by Vitek-2 NH and API NH systems. The antimicrobial susceptibility test showed that the isolate was susceptible to ceftriaxone, meropenem. Penicillin was intermediate with MIC of 0.094 μg/ml. The isolate was also sent to Institute of Medical Research (IMR), Kuala Lumpur which has confirmed the isolate as Neisseria meningitidis serogroup W135. The patient was treated with IV ceftriaxone for 1 week and kept in isolation room with contact precaution advised. Close contacts and laboratory personnel were offered post-exposure prophylaxis for those who had been exposed. He was subsequently discharged well. Discussion: Neisseria meningitidis is frequently associated with meningitis and meningococcal disease with severe debilitating complications. It is a fastidious gram negative diplococci, which is found in humans, as the only reservoir. It is transmissible by droplets from the nasopharynx of colonized persons. This organism commonly causes meningococcemia and acute meningitis. However, meningococcal pneumonia was being infrequently reported, partly due to low clinical suspicion and uncertainty to establish diagnosis of pneumonia. Many cases were initially misidentified hence the need for high clinical suspicion and precise laboratory identifications in suspected cases. Conclusion: Here, we reported a case of primary meningococcal pneumonia. The patient did not succumb to any neurological complications and was discharged well after one week of ceftriaxone. Thus, Neisseria meningitidis should be considered as an aetiological agent of community-accquired pneumonia especially in the elderly.