Compartmentalization of Interleukin-6 Response in a Patient with Septic Meningococcal Peritonitis

Abstract

We report the first case of Neisseria meningitidis-induced septic peritonitis diagnosed by PCR assay of peritoneal fluid. Concentrations of interleukin-6 were notably higher in the peritoneal fluid than in the blood. PCR diagnosis of septic meningococcal peritonitis and the pathogenesis of the disease are discussed.Case report. A previously healthy 6-year-old girl presented with a 24-h history of fever, headache, and intense myalgia. In the 2 h preceding her examination, she had developed petechiae on her abdomen, arms, face, and legs, accompanied by a deteriorating level of consciousness. Upon examination, petechial lesions were noted on both palpebral conjunctivae, and a dramatic progression from petechiae to confluent ecchymoses was observed on her skin, apparently fitting the clinical profile of disseminated intravascular coagulation. Her vital signs were as follows: axillary temperature, 38°C; pulse, 160 beats/min; respiration, 40 breaths/min; and blood pressure, 80/60 mm Hg. She was positive for Kernig's sign and Brudzinski's sign, and her Glasgow coma scale score was 13. The rest of the examination was unremarkable. The white blood cell (WBC) count was 28,000 WBCs/mm 3 (93% polymorphonuclear neutrophils, 3% lymphocytes, 4% monocytes). The hemoglobin concentration was 9.3 g/dl, and the platelet count was 58,000 cells/mm 3 . Coagulation studies demonstrated an international normalized ratio of 2.12 and an activated partial-thromboplastin time of 55 s. Abnormal laboratory values included the following serum levels: creatine kinase, 784 U/liter; albumin, 2.7 g/dl; aspartate aminotransferase, 106 U/liter; and alanine aminotransferase, 63 U/liter. The acid/base response to this clinical profile was consistent with acidemia, metabolic acidosis, and respiratory alkalosis (arterial pH, 7.28; partial O 2 pressure, 96 mm Hg; bicarbonate, 15 mmol/liter; base deficit, Ϫ3 mmol/liter; partial CO 2 pressure, 26 mmol/liter). A computed tomography scan of the brain was normal, and a lumbar puncture was performed. The cerebrospinal fluid (CSF) was cloudy and contained 1,680 WBCs/mm 3 (80% polymorphonuclear neutrophils, 15% lymphocytes, 5% monocytes), 104 mg/dl of protein, and 27 mg/dl of glucose. Gram staining of the CSF showed gram-negative diplococci, and Neisseria meningitidis serogroup C was detected by using a latex agglutination test. Blood samples and CSF samples were collected for culture. Counterimmunoelectrophoresis results for Neisseria meningitidis serogroup C in the serum were positive. The preliminary diagnosis was meningitis accompanied by meningococcemia. Therefore, antibiotic treatment was initiated with ceftriaxone (100 mg/kg of body weight/ day) and dexamethasone (0.6 mg/kg/day for 4 days). In addition, supportive measures to maintain homeostasis, including electrolyte replacement, fluid reposition, vitamin K administration, and transfusion of fresh-frozen plasma, were implemented. The patient's close contacts received chemoprophylaxis.Initially, the general status of the patient improved. However, 48 h a...

Post-genomics ofNeisseria meningitidis: an update

“…However, for a more comprehensive understanding of meningococcal phatophysiology, it will be imperative to systems biology scientists to also focus their attention on those strains that can penetrate compartments other than the leptomeninges, such as the pericardial sac [65] and the peritoneal compartment [66]. In fact, meningococcal penetration into the pericardial and peritoneal compartments is almost unexplored, as are the environmental, bacterial and host factors that lead to such an intricate phenomenon.…”

“…In addition, experimental evidences exist for the occurrence of cytokine activation within these compartments [65,66], thus suggesting that high-throughput profiling of cytokines, by means of Luminex™-based technologies, could help researchers and physicians to shed light on this intriguing phenomenon [67].…”

Pericarditis Secondary to Neisseria meningitidis: A Potential Cytokine Network Pathway

“…Unfortunately, the authors do not address a potential link between meningococcal pericarditis and cytokine network pathway. Remarkable discoveries in the universe of infectious disease have occurred in the last decades, and have expanded our scientific knowledge of the meningococcal inflammation within the vascular tree 2,3 as well as the potential of N. meningitidis to penetrate a wide range of compartments other than the leptomeninges 4–6 . However, how penetration into the pericardial compartment occurs remains unexplored.…”

“…Linkage of N. meningitidis to eukaryotic cells is an intricate phenomenon that involves multiple adhesive factors depending on the environment the bacteria encounter in us, human hosts 7 . In addition, we recently reported an intriguing phenomenon of cytokine activation in the pericardial and peritoneal compartments 5,6 . The cytokine concentrations were higher in the pericardial fluid than in blood.…”

“…The cytokine concentrations were higher in the pericardial fluid than in blood. This cytokine pattern suggests a compartmentalized inflammatory response in which cytokines are potentially synthesized by activated local cells and/or inflammatory cells that have migrated from the bloodstream to the pericardial compartment 5,6 . The higher levels of cytokines in the pericardial fluid also suggest their involvement in the pathogenesis of meningococcal pericarditis 5 .…”