Human bite leading to fatal Neisseria meningitidis septicaemia and pericarditis. Issue 5 (14th September 2015)

• Record Type: Journal Article
• Authors: Mahida, Nikunj; Anthony, Laura; Martin, Nicola; Gupta, Anindya; Andrewartha, Fiona
• Is Part Of: JMM case reports. Volume 2:Issue 5(2015)
• Publication Date: 2015-09-14
• Subjects: Cellulitis -- human bite -- Neisseria meningitidis -- pericarditis -- septicaemia; Medical microbiology -- Periodicals; 616.9041
• DOI: 10.1099/jmmcr.0.000087
• Languages: English
• ISSNs: 2053-3721

Abstract

Abstract : Introduction: Neisseria meningitidis is a human pathogen with five serogroups causing the majority of invasive disease worldwide. Pharyngeal carriage of N. meningitidis 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 N. meningitides 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.