Meningococcal Disease (Neisseria meningitidis)

2005 Case Definition

Clinical description

Meningococcal disease manifests most commonly as meningitis and/or meningococcemia that may progress rapidly to purpura fulminans, shock, and death. However, other manifestations might be observed.

Case classification

Suspect:

• Clinical purpura fulminans in the absence of a positive blood culture
• A clinically compatible case with gram negative diplococci from a normally sterile site (e.g., blood or CSF)

Probable: A clinically compatible case that has either:

• Evidence of N. meningitidis DNA using a validated polymerase chain reaction (PCR), obtained from a normally sterile site (e.g,. blood or CSF) ¹,

• Evidence of N. meningitidis antigen by immunohistochemistry (IHC) on formalin-fixed tissue or latex agglutination of CSF ^2,3

Confirmed : A clinically compatible case AND isolation of Neisseria meningitidis from a normally sterile site (e.g., blood or cerebrospinal fluid {CSF} or, less commonly, synovial, pleural, or pericardial fluid) or skin scrapings of purpuric lesions.

¹ Mothershed EA, Sacchi CT, Whitney AM, Barnett GA, Ajello GW, Schmink S, Mayer LW, Phelan M, Taylor TH Jr, Bernhardt SA, Rosenstein NE, Popovic T. 2004. Use of real-time PCR to resolve slide agglutination discrepancies in serogroup identification of Neisseria meningitidis. J Clin Microbiol 42:320-328.

² Guarner J. Greer PW. Whitney A. Shieh WJ. Fischer M. White EH. Carlone GM. Stephens DS. Popovic T. Zaki SR. Pathogenesis and diagnosis of human meningococcal disease using immunohistochemical and PCR assays; American Journal of Clinical Pathology. 122(5):754-64, 2004 Nov.

³ Positive antigen test results from urine or serum samples are unreliable for diagnosing meningococcal disease.

See also:

• 1997 Case Definition
• 1990 Case Definition

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