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Chronic meningococcal disease: Systematic literature review
Lukas P Schulz1, Beatrice Gatti1, Gregorio P Milani2
1Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Journal of Infection and Public Health
|August 6, 2025
Summary
Chronic meningococcal disease, a rare Neisseria meningitidis infection, presents insidiously with relapsing fever and skin lesions. Early molecular diagnostics and recognizing its pattern improve recognition and treatment outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Chronic meningococcal disease is an under-recognized Neisseria meningitidis infection.
- It presents insidiously, differing from acute forms and often causing diagnostic delays.
Purpose of the Study:
- To systematically review and characterize the clinical, microbiological, and epidemiological profile of chronic meningococcal disease.
- To identify key features that aid in earlier diagnosis and management.
Main Methods:
- Systematic review following PRISMA 2020 guidelines.
- Searched multiple databases for cases reported since 1960 using specific keywords.
- Extracted data on demographics, clinical features, diagnostics, microbiology, treatment, and outcomes from eligible cases.
Main Results:
- 126 cases were identified, predominantly in young adults, with recurrent fever (98%), skin lesions (95%), and musculoskeletal symptoms (90%).
- Symptoms often followed a relapsing-remitting pattern; diagnosis was delayed longer in adults.
- Neisseria meningitidis serogroups B and C were most common; meningeal signs were rare. All patients recovered with antimicrobial therapy.
Conclusions:
- Chronic meningococcal disease should be suspected in patients with relapsing fever, vasculitic lesions, and joint pain, especially with negative cultures.
- Early molecular diagnostics and awareness of characteristic patterns are crucial for improved recognition.
- The term 'relapsing-remitting meningococcal disease' may better describe its clinical presentation.
