Chronic meningococcal disease: Systematic literature review

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-07-10 DOI:10.1016/j.jiph.2025.102900

Lukas P. Schulz , Beatrice Gatti , Gregorio P. Milani , Sebastiano A.G. Lava , Camilla Lavagno , Mario G. Bianchetti , Gabriel Bronz , Lisa Kottanattu , Pietro Camozzi , Pietro B. Faré

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Abstract

Background

Chronic meningococcal disease is a rare and under-recognized manifestation of Neisseria meningitidis infection. Unlike acute meningococcal infections, its presentation is insidious, leading to diagnostic delays. We conducted a systematic review to better characterize its clinical, microbiological, and epidemiological profile.

Methods

A systematic review was performed in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42024608035). We searched Excerpta Medica, National Library of Medicine, Web of Science, Google Scholar, and bibliographies for cases reported since 1960 using the terms “chronic meningococcemia” or “chronic meningococcal disease.” Eligible cases involved previously apparently healthy individuals with N. meningitidis isolated from a normally sterile site. Two reviewers independently extracted data on demographics, clinical features, diagnostics, microbiology, treatment, and outcomes.

Results

A total of 126 cases from 97 reports were included. Most patients (median age: 21 years) presented with recurrent fever (98 %), non-blanching skin lesions (95 %), and musculoskeletal symptoms (90 %) over a period of ≥ 10 days. In over two-thirds of cases, symptoms followed a relapsing-remitting pattern, with alternating episodes of fever, rash, and joint involvement. Diagnosis was delayed longer in adults than in children (P < 0.0001). Blood cultures were positive in 77 % of cases; molecular testing and skin biopsy improved diagnostic yield. N. meningitidis serogroup B (58 %) and C (31 %) were most common. Meningeal signs were largely absent (94 %). Antimicrobial therapy led to complete recovery without sequelae in all patients. Testing for inherited susceptibility was conducted in 52 cases and revealed abnormalities - primarily complement deficiencies - in 13 (23 %) of them.

Conclusions

Chronic meningococcal disease should be considered in individuals with relapsing fever, vasculitic skin lesions, and joint involvement, especially when cultures are negative or symptoms mimic viral or autoimmune conditions. Early use of molecular diagnostics and awareness of characteristic patterns may improve recognition. The term "relapsing-remitting meningococcal disease" may better reflect its clinical nature.

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慢性脑膜炎球菌病：系统文献综述

背景：慢性脑膜炎球菌病是脑膜炎奈瑟菌感染的一种罕见且未被充分认识的表现。与急性脑膜炎球菌感染不同，其表现隐匿，导致诊断延误。我们进行了一项系统综述，以更好地描述其临床、微生物学和流行病学概况。方法按照PRISMA 2020指南进行系统评价，并在PROSPERO注册（CRD42024608035）。我们用“慢性脑膜炎球菌血症”或“慢性脑膜炎球菌病”这两个词检索了医学摘录、国家医学图书馆、科学网、谷歌学者和1960年以来报告病例的参考书目。符合条件的病例涉及从正常无菌部位分离出表面健康的脑膜炎奈瑟菌个体。两名审稿人独立提取了人口统计学、临床特征、诊断、微生物学、治疗和结果方面的数据。结果97份报告共纳入126例病例。大多数患者（中位年龄：21岁）在≥ 10天的时间内表现为反复发热（98 %），非漂白皮肤病变（95 %）和肌肉骨骼症状（90 %）。在超过三分之二的病例中，症状遵循复发缓解模式，伴有发热、皮疹和关节受累的交替发作。成人的诊断延迟时间长于儿童（P <； 0.0001）。77%的病例血培养阳性（ %）；分子检测和皮肤活检提高了诊断率。脑膜炎奈塞菌血清B组（58 %）和C组（31 %）最为常见。脑膜征象基本不存在（94% %）。抗菌药物治疗使所有患者完全康复，无后遗症。对52例进行了遗传易感性检测，其中13例（23% %）发现异常，主要是补体缺乏。结论有回归热、血管性皮肤病变和关节受累的患者应考虑慢性脑膜炎球菌病，特别是当培养阴性或症状类似病毒或自身免疫性疾病时。早期使用分子诊断和特征模式的认识可能会提高识别。术语“复发-缓解型脑膜炎球菌病”可能更好地反映其临床性质。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.