1887

Abstract

Introduction:

is a human pathogen with five serogroups causing the majority of invasive disease worldwide. Pharyngeal carriage is known to occur, but it is not considered a significant pathogen in skin and soft tissue infections secondary to human bites. We present a rare case of meningococcal septicaemia and pericarditis resulting from a human bite to the breast.

Case presentation:

A 43-year-old female with type 2 diabetes mellitus and hypertension presented with fever, tachycardia, hypotension and a history of a human bite to the left breast. On examination, there was an erythematous, infected wound on the left breast. Blood cultures obtained on admission were positive for subtype W and the patient was treated for 7 days with intravenous ceftriaxone. However, the patient was readmitted 10 days later with a relapse of fever, dyspnoea and chest pain. A chest X-ray showed an enlarged cardiac silhouette, and echocardiography confirmed the presence of a large pericardial effusion. Intravenous ceftriaxone was recommenced and an urgent pericardiocentesis performed to relieve the cardiac tamponade. Blood cultures remained sterile and no organisms were detected from the pericardial fluid.

Conclusion:

The patient unfortunately suffered a cardiopulmonary arrest and died while undergoing treatment. A post-mortem examination revealed myocardial necrosis and inflammatory debris within the pericardial sac. The most likely pathogenesis was considered to be inflammatory pericarditis secondary to meningococcal septicaemia with subsequent cardiac tamponade.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.000087
2015-10-09
2021-10-16
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/2/5/jmmcr000087.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.000087&mimeType=html&fmt=ahah

References

  1. Ala'Aldeen D. A., Neal K. R., Ait-Tahar K., Nguyen-Van-Tam J. S., English A., Falla T. J., Hawkey P. M., Slack R. C. 2000; Dynamics of meningococcal long-term carriage among university students and their implications for mass vaccination. J Clin Microbiol 38:2311–2316[PubMed]
    [Google Scholar]
  2. Ala'Aldeen D. A., Oldfield N. J., Bidmos F. A., Abouseada N. M., Ahmed N. W., Turner D. P., Neal K. R., Bayliss C. D. 2011; Carriage of meningococci by university students, United Kingdom. Emerg Infect Dis 17:1762–1763 [View Article][PubMed]
    [Google Scholar]
  3. Al Fallouji M. 1990; Traumatic love bites. Br J Surg 77:100–101 [View Article][PubMed]
    [Google Scholar]
  4. Blaser M. J., Reingold A. L., Alsever R. N., Hightower A. 1984; Primary meningococcal pericarditis: a disease of adults associated with serogroup C Neisseria meningitidis . Rev Infect Dis 6:625–632 [View Article][PubMed]
    [Google Scholar]
  5. Cartolano G. L., Barbier C., Arnoult L., Simon D., Ricome J. L., Hayon J. 2003; Fatal acute cellulitis due to Neisseria meningitidis . J Clin Microbiol 41:3996–3997 [View Article][PubMed]
    [Google Scholar]
  6. Cartwright K. A. V., Stuart J. M., Jones D. M., Noah N. D. 1987; The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica . Epidemiol Infect 99:591–601 [View Article][PubMed]
    [Google Scholar]
  7. Cartwright K. A. V., Jones D. M., Smith A. J., Stuart J. M., Kaczmarski E. B., Palmer S. R. 1991; Influenza A and meningococcal disease. Lancet 338:554–557 [View Article][PubMed]
    [Google Scholar]
  8. Caugant D. A., Maiden M. C. 2009; Meningococcal carriage and disease–population biology and evolution. Vaccine 27:Suppl. 2B64–B70 [View Article][PubMed]
    [Google Scholar]
  9. Chand D. V., Hoyen C. K., Leonard E. G., McComsey G. A. 2005; First reported case of Neisseria meningitidis periorbital cellulitis associated with meningitis. Pediatrics 116:e874–e875 [View Article][PubMed]
    [Google Scholar]
  10. Clark D. C. 2003; Common acute hand infections. Am Fam Physician 68:2167–2176[PubMed]
    [Google Scholar]
  11. Conlon H. A. 2007; Human bites in the classroom: incidence, treatment, and complications. J Sch Nurs 23:197–201 [View Article][PubMed]
    [Google Scholar]
  12. Coureuil M., Join-Lambert O., Lécuyer H., Bourdoulous S., Marullo S., Nassif X. 2012; Mechanism of meningeal invasion by Neisseria meningitidis . Virulence 3:164–172 [View Article][PubMed]
    [Google Scholar]
  13. Ejlertsen T., Vesterlund T., Schmidt E. B. 1988; Myopericarditis with cardiac tamponade caused by Neisseria meningitidis serogroup W135. Eur J Clin Microbiol Infect Dis 7:403–404 [View Article][PubMed]
    [Google Scholar]
  14. Finkelstein Y., Adler Y., Nussinovitch M., Varsano I., Amir J. 1997; A new classification for pericarditis associated with meningococcal infection. Eur J Pediatr 156:585–588 [View Article][PubMed]
    [Google Scholar]
  15. Goldstein E. J., Citron D. M., Wield B., Blachman U., Sutter V. L., Miller T. A., Finegold S. M. 1978; Bacteriology of human and animal bite wounds. J Clin Microbiol 8:667–672[PubMed]
    [Google Scholar]
  16. Health Protection Agency 2012 Guidance for Public Health Management of Meningococcal Disease in the UK London: Public Health England; https://www.gov.uk/government/publications/meningococcal-disease-guidance-on-public-health-management
    [Google Scholar]
  17. Hill D. J., Griffiths N. J., Borodina E., Virji M. 2010; Cellular and molecular biology of Neisseria meningitidis colonization and invasive disease. Clin Sci (Lond) 118:547–564[PubMed] [CrossRef]
    [Google Scholar]
  18. Howe R. A., Andrews J. M., BSAC Working Party on Susceptibility Testing. 2012; BSAC standardized disc susceptibility testing method (version 11). J Antimicrob Chemother 67:2783–2784 [View Article][PubMed]
    [Google Scholar]
  19. Jones G. R., Lowes J. A. 1996; The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis. QJM 89:515–522 [View Article][PubMed]
    [Google Scholar]
  20. NICE 2010 Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary CareNICE Clinical Guideline 102 Manchester, UK: National Institute for Health and Care Excellence; https://www.nice.org.uk/guidance/cg102/
    [Google Scholar]
  21. Perl B., Gottehrer N. P., Raveh D., Schlesinger Y., Rudensky B., Yinnon A. M. 1999; Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis 29:1483–1488 [View Article][PubMed]
    [Google Scholar]
  22. Public Health England 2014 UK immunisation schedule: the green book, chapter 11 London: Public Health England; https://www.gov.uk/government/publications/immunisation-schedule-the-green-book-chapter-11
    [Google Scholar]
  23. Stanwell-Smith R. E., Stuart J. M., Hughes A. O., Robinson P., Griffin M. B., Cartwright K. 1994; Smoking, the environment and meningococcal disease: a case control study. Epidemiol Infect 112:315–328 [View Article][PubMed]
    [Google Scholar]
  24. Stevens D. L., Bisno A. L., Chambers H. F., Everett E. D., Dellinger P., Goldstein E. J., Gorbach S. L., Hirschmann J. V., Kaplan E. L., other authors. 2005; Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 41:1373–1406 [Erratum: Clin Infect Dis 41, 1830; Clin Infect Dis 42, 1219]. [View Article][PubMed]
    [Google Scholar]
  25. Talan D. A., Abrahamian F. M., Moran G. J., Citron D. M., Tan J. O., Goldstein E. J., Emergency Medicine Human Bite Infection Study Group. 2003; Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis 37:1481–1489 [View Article][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.000087
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.000087
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error