Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia

Arch Dermatol. 2008 Jun;144(6):770-3. doi: 10.1001/archderm.144.6.770.

Abstract

Background: Chronic meningococcemia (CM) is a diagnostic challenge. Skin lesions are frequent but in most cases nonspecific. Polymerase chain reaction (PCR)-based diagnosis has been validated in blood and cerebrospinal fluid for acute Neisseria meningitidis infection, in patients in whom routine microbiologic tests have failed to isolate the bacteria. In 2 patients with CM, we established the diagnosis by a newly developed PCR-based approach performed on skin biopsy specimens.

Observations: Two patients presented with fever together with systemic and cutaneous manifestations suggestive of CM. Although findings from blood cultures remained negative, we were able to identify N meningitidis in the skin lesions by a newly developed PCR assay. In 1 patient, an N meningitidis strain of the same serogroup was also isolated from a throat swab specimen. Both patients rapidly improved after appropriate antibiotherapy.

Conclusions: To our knowledge, we report the first cases of CM diagnosed by PCR testing on skin biopsy specimens. It is noteworthy that, although N meningitidis-specific PCR is highly sensitive in blood and cerebrospinal fluid in acute infections, our observations underscore the usefulness of PCR performed on skin lesions for the diagnosis of chronic N meningitidis infections. Whenever possible, this approach should be systematically employed in patients for whom N meningitidis infection cannot be confirmed by routine microbiologic investigations.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Bacteremia / diagnosis*
  • Bacteremia / etiology
  • Biopsy
  • Chronic Disease
  • DNA, Bacterial / analysis*
  • Diagnosis, Differential
  • Humans
  • Male
  • Meningococcal Infections / diagnosis*
  • Meningococcal Infections / microbiology
  • Neisseria meningitidis / genetics*
  • Neisseria meningitidis / isolation & purification
  • Polymerase Chain Reaction / methods*
  • Skin / microbiology*
  • Skin / pathology
  • Skin Diseases, Bacterial / complications
  • Skin Diseases, Bacterial / diagnosis*
  • Skin Diseases, Bacterial / microbiology

Substances

  • DNA, Bacterial