Pericarditis caused by hyperinvasive strain of neisseria meningitidis, Sardinia, Italy, 2015

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From: Emerging Infectious Diseases(Vol. 22, Issue 6)
Publisher: U.S. National Center for Infectious Diseases
Document Type: Letter to the editor
Length: 1,215 words
Lexile Measure: 1230L

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To the Editor: Invasive meningococcal disease is usually defined by the occurrence of meningitis or septicemia. Pericarditis might occur during the course of invasive infection. This clinical picture, defined as disseminated meningococcal disease with pericarditis (1) or secondary meningococcal pericarditis, was reported in 1918 (2). In 1939, primary or isolated meningococcal pericarditis (1,3) was described. In this form of pericarditis, pericardial or blood cultures are positive for Neisseria meningitidis but there is no meningeal involvement or clinical meningococcemia (4).

Since its description, several cases of primary meningococcal pericarditis have been reported (5). Although its pathogenesis remains largely undefined, it has been hypothesized that the onset of primary pericarditis occurs after a transient bacteremia or as a consequence of involvement of the lower respiratory tract (4). Blaser et al. reported that serogroup C meningococci are usually associated with this disease, especially in adults. However, serogroups B, W, and Y have also been identified (4). We report a case-patient with primary meningococcal pericarditis caused by a serogroup C strain of N. meningitidis.

The patient was a 32-year-old man who lived in Sardinia, Italy. He had no predisposing factors, such as immunodeficiency or other chronic disorders. Disease onset occurred on August 29, 2015. Clinical manifestations were fever (temperature 38[degrees]C), hypotension, epigastralgia, arthralgia, asthenia, chest pain, and reduced vesicular murmur. The left ventricle was widely hypokinetic, and a light ST increase was observed. A blood culture was positive for N. meningitidis.

The patient was given piperacillin/tazobactam (4.5 g 3*/d) and metronidazole (500 mg 3*/d) for 4 days. After 4 days, treatment with ceftriaxone (2 g 2*/d) for 4 days was started. Because of persistent fever (38.8[degrees]C), levofloxacin (500 mg 2*/d) for 23 days was also started on day 7. On day 10, ceftriaxone was replaced with piperacillin/tazobactam (4.5 g 4*/d) for 21 days. A major bilateral pleural...

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