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


METHODS
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.
Polyclinique de Dermatologie et Vénéréologie, Hôpital Universitaire de Genève, Rue Micheli-du-Crest 24, 1211 Genève 14, Switzerland. laurent.parmentier@chu-lyon.fr
Laurent
L
Parmentier
Christian
C
Garzoni
Christophe
C
Antille
Laurent
L
Kaiser
Béatrice
B
Ninet
Luca
L
Borradori
D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000175:diagnosis* / Q000209:etiology; D001706:Biopsy; D002908:Chronic Disease; D004269:DNA, Bacterial / Q000032:analysis*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008589:Meningococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D009345:Neisseria meningitidis / Q000235:genetics* / Q000302:isolation & purification; D016133:Polymerase Chain Reaction / Q000379:methods*; D012867:Skin / Q000382:microbiology* / Q000473:pathology; D017192:Skin Diseases, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology
D004269:DNA, Bacterial