Presentation with gastrointestinal symptoms and high case fatality associated with group W meningococcal disease (MenW) in teenagers, England, July 2015 to January 2016

Abstract

Atypical clinical presentations associated with group W meningococcal disease (MenW) are well-described and include pneumonia, septic arthritis, endocarditis and epiglottitis/supraglottitis. Following anecdotal reports of teenagers presenting with predominantly gastrointestinal symptoms, we undertook a case review of MenW cases in 15 to 19 year-olds diagnosed in England between July 2015 and January 2016. Of the 15 cases, seven presented with a short history of nausea, vomiting and diarrhoea; five of these seven cases died within 24 hours of presentation to hospital.

Necrotising fasciitis as atypical presentation of infection with emerging Neisseria meningitidis serogroup W (MenW) clonal complex 11, the Netherlands, March 2017

“…Blood cultures remained negative, but these were mistakenly drawn after antimicrobial treatment had already been started. The preceding gastrointestinal symptoms could have been related to the MenW infection as was recently described by others [6,7], but they might be a remarkable coincidence as the necrotising fasciitis symptoms did not develop until 3 days later. Reported cases of MenW with gastrointestinal symptoms quickly progressed into septicaemia [7].…”

“…Infections due to MenW may present differently from the classical clinical presentation of N. meningitidis such as meningitis or septicaemia; for example, gastrointestinal presentations have been reported with MenW [6,7]. Necrotising fasciitis can be caused by various bacterial pathogens, but in monomicrobial infections, haemolytic Streptococci group A are most commonly identified as the cause [8].…”

Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative

“…39,42 In Europe and the United Kingdom, MenW has also been found to present atypical symptoms such as diarrhea and vomiting without classic signs of meningitis or hemorrhagic rash. 43 There is a need for surveillance that combines exhaustive reporting and microbiological typing. As previous genotyping studies were unable to discriminate sporadic and epidemic MenW isolates reliably, WGS should and can be the standard typing scheme for MenW isolates given that techniques such as MLST do not provide sufficient resolution.…”

An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup W strain, Scotland and Sweden, July to August 2015

“…The four Scottish isolates also underwent FetA and multilocus sequence typing (MLST) and, again, were identical to one another (FetA F1–1 and sequence type (ST)-11) [3]. ST-11 is part of the ST-11 clonal complex (cc11) which is associated with multiple serogroups, a tendency to cause outbreaks and epidemics, atypical clinical presentations, and relatively high case fatality rates [5]. Serogroup C cc11, for example, has caused outbreaks among military recruits [6], university undergraduates [7] and more recently, men who have sex with men [8].…”