title: Neisseria meningitidis endogenous endophthalmitis with meningitis in an immunocompetent child.
abstract: Neisseria meningitidis is a major cause of childhood morbidity and mortality worldwide. We describe an exceptional case of an immunocompetent 15-month-old child presenting with a unilateral anterior uveitis, hypopyon, and sepsis. Anterior chamber aspirate demonstrated gram-negative cocci before Neisseria meningitidis was identified in blood and cerebrospinal fluid. Meningococcal endophthalmitis presents variably with sepsis, meningitis, or isolated ocular symptoms. Diagnosis is a clinical challenge, requiring diagnostic sampling and treatment from both pediatricians and ophthalmologists. Delayed or incorrect treatment risks blindness, disability, or death. Simultaneous invasion of meningococcus across intact blood-brain and blood-ocular barriers in this child suggests antigenic correlates between meningeal and ocular endothelial interfaces. Meningococcus is an exclusively human pathogen; research is hampered by the lack of animal models. This clinical observation suggests the potential of a novel in vitro experimental approach of using ocular tissue from eye banks to further elucidate the meningococcal-endothelial interaction that underpins meningococcal disease.
authors.affiliation: Stoke Mandeville Hospital, Department of Ophthalmology , Mandeville Road, Aylesbury , UK.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Yusuf
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Sipkova
authors.forename: Sejal
authors.initials: S
authors.lastname: Patel
authors.forename: Larry
authors.initials: L
authors.lastname: Benjamin
mesh_terms: D000867:Anterior Chamber / Q000382:microbiology*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D009877:Endophthalmitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D008589:Meningococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D009345:Neisseria meningitidis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction
chemical_list: D004269:DNA, Bacterial
keywords: Blood-brain barrier; blood-ocular barrier; endogenous endophthalmitis; endothelium; hypopyon; meningcoccal sepsis; meningitis; meningococcus