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Neisseria meningitidis serogroup C causing primary polyarthritis in an octogenarian
Thomas William Noteman1, Taegyeong Tina Ha1, Elan Micha Tsarfati2
1Trauma & Orthopaedics, NHS Forth Valley, Larbert, UK.
Abstract:
A man in his 80s presented to the hospital with a 36-hour history of fever, myalgia, bilateral shoulder and right knee pain. Joint fluid aspirates from his shoulders and right knee isolated Gram-negative diplococci. After failing to grow on standard and selective media, Neisseria meningitidis was identified by 16s PCR and subsequently typed as serogroup C. He had no clinical features of meningitis or meningococcaemia. Blood cultures were negative and an EDTA blood sample was negative for meningococcal ctrA gene. Urine PCR was negative for Neisseria gonorrhoeae He was treated successfully with two arthroscopic joint washouts of his right knee, aspirates of both shoulders, 40 days of intravenous ceftriaxone and intensive physiotherapy as both an inpatient and outpatient. In the literature, we have not found any previously documented cases of serogroup C meningococcus causing polyarticular primary septic arthritis in this age group or guidance on duration of antibiotic treatment. Literature on the impact of rehabilitation to baseline function was also found to be lacking. Although rare, primary meningococcal arthritis (PMA) should be considered as a differential diagnosis in cases of acute polyarticular septic arthritis. Polyarticular PMA in older adults may require prolonged rehabilitation before one might expect to return to premorbid function.
Insights
A rare case of serogroup C meningococcal polyarticular septic arthritis occurred in an elderly man. This highlights the need to consider primary meningococcal arthritis in older adults with joint infections.
Area of Science:
- Infectious Diseases
- Rheumatology
- Microbiology
Background:
- Primary meningococcal arthritis (PMA) is a rare condition, typically affecting younger individuals.
- Serogroup C Neisseria meningitidis is a significant cause of meningitis and sepsis, but isolated polyarticular septic arthritis is uncommon.
Observation:
- An elderly male patient presented with acute polyarticular septic arthritis affecting bilateral shoulders and the right knee.
- Joint fluid analysis revealed Gram-negative diplococci, later identified as serogroup C Neisseria meningitidis via 16S rRNA PCR.
- The patient lacked typical clinical signs of meningitis or meningococcemia, and blood/urine cultures were negative.
Findings:
- This case represents a rare instance of serogroup C Neisseria meningitidis causing polyarticular primary septic arthritis in an elderly patient.
- Successful treatment involved joint washouts, intravenous ceftriaxone for 40 days, and intensive physiotherapy.
- No established guidelines exist for the duration of antibiotic treatment or the impact of rehabilitation on functional recovery in such cases.
Implications:
- Primary meningococcal arthritis should be considered in the differential diagnosis of acute polyarticular septic arthritis, particularly in elderly individuals.
- Polyarticular PMA in older adults may necessitate prolonged rehabilitation to achieve functional recovery.
- Further research is needed to establish optimal treatment durations and rehabilitation protocols for PMA in the elderly.
