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Neonatal invasive meningococcal disease: Clinical case from Saudi Arabia and updated review of reported cases
Ahmed A Muyidi1, Ibrahim A Al-Zaydani2, Salman J Alzahrani3
1Abha Maternity and Children Hospital (AMCH), Medical and Molecular Microbiology Laboratory, Ministry of Health (MOH), Abha, Saudi Arabia.
Abstract:
Neonatal invasive meningococcal disease (IMD) is rare but associated with severe morbidity and mortality. We report an 11-day-old male neonate who presented with fever, apnea, and poor feeding and was diagnosed with meningitis due to Neisseria meningitidis. Diagnosis was confirmed by blood culture and cerebrospinal fluid (CSF) multiplex PCR, although CSF culture remained negative. The patient developed ventriculitis, requiring prolonged antimicrobial therapy. To contextualize this case, we reviewed 71 previously reported neonatal IMD cases published between 1916 and 2024. The present case is discussed alongside these reports for comparison. Among the 54 cases with reported clinical symptoms, fever (31/54, 57.4%) and irritability (23/54, 42.6%) were the most frequent clinical signs, while petechiae were documented in 12/54 cases (22.2%). Serogroup B predominated among cases with available serogroup data (23/39, 59.0%). Among the 71 previously reported cases, mortality occurred in 22/71 cases (31.0%), while hydrocephalus (8/71, 11.3%) and seizures (7/71, 9.9%) were the most frequently reported complications. This case highlights diagnostic challenges in neonatal IMD, particularly in culture-negative disease, and underscores the importance of molecular diagnostics. Preventive strategies such as improved serogroup surveillance may reduce IMD burden in neonates, maternal immunization remains investigational.
Insights
Neonatal invasive meningococcal disease (IMD) is rare but serious. This case and review highlight diagnostic challenges, the importance of molecular methods for culture-negative cases, and the need for better prevention strategies in neonates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Neonatal invasive meningococcal disease (IMD) is a rare but severe condition with high mortality.
- Early diagnosis and treatment are crucial for improving outcomes in affected neonates.
Purpose of the Study:
- To report a case of neonatal IMD with diagnostic challenges.
- To contextualize this case by reviewing historical data on neonatal IMD.
- To emphasize the role of molecular diagnostics and discuss preventive strategies.
Main Methods:
- Case report of an 11-day-old male neonate diagnosed with Neisseria meningitidis meningitis.
- Diagnostic confirmation using blood culture and cerebrospinal fluid (CSF) multiplex PCR.
- Systematic review of 71 previously reported neonatal IMD cases (1916-2024).
Main Results:
- The reported case involved meningitis and ventriculitis, with negative CSF culture but positive PCR.
- Fever and irritability were the most common symptoms in reviewed cases (57.4% and 42.6%).
- Serogroup B was predominant (59.0%), and overall mortality was 31.0%, with hydrocephalus and seizures as frequent complications.
Conclusions:
- Neonatal IMD presents diagnostic difficulties, especially in culture-negative scenarios, underscoring the value of molecular diagnostics.
- Improved serogroup surveillance and potential maternal immunization strategies are needed to reduce the burden of neonatal IMD.
- This case highlights the persistent challenges and evolving diagnostic approaches for invasive meningococcal disease in newborns.
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