Location
Moultrie, GA
Start Date
7-5-2025 1:00 PM
End Date
7-5-2025 4:00 PM
Description
Introduction:
Meningococcal sepsis caused by Neisseria meningitidis is a rare but life-threatening infection, especially in pregnant women, where the risk of rapid deterioration can occur. The diagnosis of sepsis due to N. meningitidis in early pregnancy is particularly challenging due to limited treatment options that are safe for both mother and fetus. This case highlights the clinical course, diagnosis, and management of Neisseria meningitidis bacteremia in an 8-week pregnant woman, providing valuable insights for clinicians treating systemic infections in pregnancy.
Case Presentation:
A 29-year-old female, gravida 4 para 2012, at 8 weeks and 6 days gestation with no other contributory past medical history presented to the emergency department at Colquitt Regional Medical Center with a one-day history of fever (Tmax 101), headache, neck and back pain, chills, and nausea. On physical examination, the patient was alert but uncomfortable, with tachycardia and midline neck and back tenderness, without neurological deficits, meningism, or rash. Initial lab results showed leukocytosis (WBC 32.4), mild hyponatremia, hypochloremia, and elevated procalcitonin (21.8 ng/mL), indicating an infectious process. An initial lumbar puncture attempt was unsuccessful. A broad differential diagnosis was considered, and empiric broad-spectrum antibiotics (Rocephin, vancomycin, and ampicillin) were initiated due to concerns for possible infection, including meningitis. Blood cultures obtained on admission returned positive for Neisseria meningitidis 72 hours later. Despite initial suspicion of meningitis, cerebrospinal fluid analysis from a second successful lumbar puncture revealed clear, colorless fluid with 4 WBCs and no bacterial growth. The final diagnosis was sepsis due to Neisseria meningitidis bacteremia. Antibiotic therapy was adjusted to Rocephin and ampicillin. Infectious disease and obstetrics consultations were requested, and the patient was managed with intravenous fluids and close telemetry monitoring. Her condition improved over the next few days, with repeat blood cultures negative at 48 hours. The patient was discharged on 02/28/2025 with a PICC line for continued intravenous antibiotics.
Conclusion
This case presents a rare and serious occurrence of Neisseria meningitidis bacteremia in early pregnancy, initially mimicking other infectious processes such as meningitis. The prompt recognition of sepsis, combined with timely blood cultures and appropriate use of safe antibiotics, contributed to a positive clinical outcome. This case underscores the importance of timely identification and management of infections in pregnancy, the need for multidisciplinary care, and the critical role of appropriate follow-up care and public health measures, including post-exposure prophylaxis for close contacts.
Embargo Period
6-3-2025
Included in
Meningococcal Sepsis in Pregnancy: A Case of Neisseria meningitidis Bacteremia in the First Trimester
Moultrie, GA
Introduction:
Meningococcal sepsis caused by Neisseria meningitidis is a rare but life-threatening infection, especially in pregnant women, where the risk of rapid deterioration can occur. The diagnosis of sepsis due to N. meningitidis in early pregnancy is particularly challenging due to limited treatment options that are safe for both mother and fetus. This case highlights the clinical course, diagnosis, and management of Neisseria meningitidis bacteremia in an 8-week pregnant woman, providing valuable insights for clinicians treating systemic infections in pregnancy.
Case Presentation:
A 29-year-old female, gravida 4 para 2012, at 8 weeks and 6 days gestation with no other contributory past medical history presented to the emergency department at Colquitt Regional Medical Center with a one-day history of fever (Tmax 101), headache, neck and back pain, chills, and nausea. On physical examination, the patient was alert but uncomfortable, with tachycardia and midline neck and back tenderness, without neurological deficits, meningism, or rash. Initial lab results showed leukocytosis (WBC 32.4), mild hyponatremia, hypochloremia, and elevated procalcitonin (21.8 ng/mL), indicating an infectious process. An initial lumbar puncture attempt was unsuccessful. A broad differential diagnosis was considered, and empiric broad-spectrum antibiotics (Rocephin, vancomycin, and ampicillin) were initiated due to concerns for possible infection, including meningitis. Blood cultures obtained on admission returned positive for Neisseria meningitidis 72 hours later. Despite initial suspicion of meningitis, cerebrospinal fluid analysis from a second successful lumbar puncture revealed clear, colorless fluid with 4 WBCs and no bacterial growth. The final diagnosis was sepsis due to Neisseria meningitidis bacteremia. Antibiotic therapy was adjusted to Rocephin and ampicillin. Infectious disease and obstetrics consultations were requested, and the patient was managed with intravenous fluids and close telemetry monitoring. Her condition improved over the next few days, with repeat blood cultures negative at 48 hours. The patient was discharged on 02/28/2025 with a PICC line for continued intravenous antibiotics.
Conclusion
This case presents a rare and serious occurrence of Neisseria meningitidis bacteremia in early pregnancy, initially mimicking other infectious processes such as meningitis. The prompt recognition of sepsis, combined with timely blood cultures and appropriate use of safe antibiotics, contributed to a positive clinical outcome. This case underscores the importance of timely identification and management of infections in pregnancy, the need for multidisciplinary care, and the critical role of appropriate follow-up care and public health measures, including post-exposure prophylaxis for close contacts.
Comments
Presented by Madison Morgan.