Neisseria gonorrhoeae: An Unexpected Cause of Polyarthritis and Meningitis

Abstract

Neisseria gonorrhoeae, a gram-negative coccus, is a major cause of morbidity among sexually active individuals. Hematogenous spread of N gonorrhoeae from the initial site of infection is thought to occur in only 0.5% to 3% of infected patients. Disseminated gonococcal infections can rarely lead to serious sequelae, such as endocarditis or meningitis. In this article, we present a case that demonstrates a rare finding of disseminated gonococcal infection leading to N gonorrhoeae meningitis, complicated by hydrocephalus. The patient in this case initially presented with intermittent polyarthralgias for two years and later developed a rash. Cultures from blood and joint aspirate were negative. Urine nucleic acid amplification test for N gonorrhoeae was also negative. He was initially started on steroids for what was believed at first to be an autoimmune polyarthritis. The patient later developed acute encephalopathy. Head imaging revealed hydrocephalus. Cerebrospinal fluid analysis was consistent with bacterial meningitis. Blood, joint, and mucosal membrane studies failed to isolate the causative organism, but his cerebrospinal fluid grew N gonorrhoeae. He was treated with high-dose intravenous ceftriaxone for two weeks with rapid improvement in his mental status and resolution of his joint pains and rash.

Phylogenetic Classification and Functional Review of Autotransporters

“…These are respiratory pathogens that can disseminate to cause meningitis (136)(137)(138). IgA protease is also expressed by Neisseria gonorrhoeae, a urogenital pathogen that can spread to cause septic arthritis and endocarditis (139,140). SLAT functions are well-suited to such pathogens including immune evasion and adhesion to host and bacterial surfaces, which promotes mucosal colonization, as well as tissue damage, which is often required for dissemination.…”

Osteoartikuläre und rheumatologische Manifestationen sexuell übertragbarer Infektionen

“…Abgrenzend zur reaktiven Arthritis können weitere arthritische Manifestationen durch STIs entstehen. Differenzialdiagnostisch sind das ebenfalls immunologisch getriggerte Polyarthritis-Dermatitis-Syndrom bei disseminierten Gonokokken-Infektionen oder die akute septische Gelenkarthritis durch Gonokokken oder genitale Mykoplasmen zu nennen [3,[14][15][16][17][18].…”

“…Osteolytische Läsionen, mit oder ohne Periostitis, treten am häufigsten im Schädel oder in der Wirbelsäule auf [19]. Chlamydia trachomatis [3,33,34] Allgemeines/Epidemiologie Neisseria gonorrhoea [3,16,35,36] Allgemeines/Epidemiologie Literatur…”

Vaccine Candidates for the Control and Prevention of the Sexually Transmitted Disease Gonorrhea

“…Most N. gonorrhoeae strains that disseminate do not cause urethritis, but infection of a mucosal site usually precedes cases of disseminated disease [29]. Although uncommon, disseminated disease can cause arthritisdermatitis syndrome [30] and in rare cases endocarditis or meningitis [31][32][33][34]. Infection with N. gonorrhoeae can also facilitate transmission or acquisition of the human immunodeficiency virus type 1 (HIV-1) [35][36][37][38][39], and infection with N. gonorrhoeae has been reported to repress HIV-1 replication in macrophages inducing a state similar to viral latency [40].…”