title: A complicated simple fall--an atypical case of serogroup Y meningococcal pneumonia with secondary septicaemia and literature review.
abstract: An elderly lady was admitted for pain management and rehabilitation following a fall. During her stay she developed a new heart murmur and sepsis. Subacute bacterial endocarditits was excluded, empirical ciprofloxacin was initiated and later converted to aztreonam with gentamicin for clinical deterioration. Subsequent investigations revealed meningococcal Y septicaemia secondary to pneumonia, with a possible oropharynx focus. Upon discharge she had returned to baseline state. The case reflects an unusual and increasing cause of pneumonia. A steady increase of infective serogroup Y isolates over the past 12-years in England, with tendency towards elderly makes it a significant differential among the general medical population. This trend corresponds with the US, but is yet unknown whether to be a periodic cycle or true change in dominance and, or, virulence among serogroups. If the latter were true, it would support the inclusion of serogroups beyond menigitides C in the vaccination program.
authors.affiliation: Department of Endocrinology and General Medicine, Royal Liverpool University Hospital, Liverpool, UK. benjaminchan@doctors.org.uk
authors.forename: B K Y
authors.initials: BK
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Kudsk-Iversen
authors.forename: S
authors.initials: S
authors.lastname: Balaguruswamy
authors.forename: T S
authors.initials: TS
authors.lastname: Purewal
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008589:Meningococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D022401:Meningococcal Vaccines; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy; D012703:Serotyping
chemical_list: D000900:Anti-Bacterial Agents; D022401:Meningococcal Vaccines