Heart damage during meningococcal infection

Background. Meningococcal infection (MI) remains relevant in the modern world. In the Russian Federation, there is currently an increase in cases of meningococcal infection in the adult population. While the generalized form of meningococcal infection presents a recognizable clinical picture with the development of hemorrhagic rash and meningitis, localized and rare forms of this infection are diagnosed extremely rarely. The true proportion of rare forms in the structure of meningococcal infection remains unknown. Cardiac involvement is the most commonly registered rare form of meningococcal infection after pneumonia; it can manifest as endocarditis, myocarditis, and pericarditis. The present paper provides a literature review of available data on the forms, pathogenesis, clinical picture, diagnosis, and approaches to the treatment of meningococcal pericarditis, myocarditis, and endocarditis. The nonspecificity of clinical symptoms and laboratory tests makes it difficult to suspect meningococcal infection in patients with cardiac infections. The lack of availability in real clinical practice of diagnostic methods such as MRI, endomyocardial biopsy, and pericardiocentesis leads to low detection of these forms, especially in patients with isolated cardiac involvement of meningococcal etiology. The need for selective nutrient media to detect the pathogen also contributes to the lack of identification of the etiological factor.

Conclusion. A significant problem is the absence of clinical recommendations and treatment protocols for meningococcal cardiac involvement in patients without signs of the generalized form of MI. The complexity of diagnosing and treating meningococcal pericarditis is illustrated in the present paper by a clinical example.

1. Vilnits A. A., Lobzin Yu. V., Skripchenko N. V., et. al.. Meningococcal infection in children in the period 2012-2021. Main results of a retrospective multicenter study, issues of the day. Zhurnal infektologii. 2023; 15 (4): 5-13. (In Russ.) https://doi.org/10.22625/2072-6732-2023-15-4-5-13.

2. Koroleva M. A., Gritsai M. I., Koroleva I. S., et al. Purulent bacterial meningitis in the Russian Federation: Epidemiology and vaccine prophylaxis. ZNiSO. 2022; 12. (In Russ.)

3. Clinical guidelines "Meningococcal infection in adults. Meningitis. Non-profit partnership "National Scientific Society of Infectious Diseases". 30 October 2014. (In Russ.)

4. Vossen M., Mitteregger D., Steininger C. Meningococcal pneumonia. Vaccine. 2016; 34 (37): 4364-4370. DOI: 10.1016/j.vaccine.2016.07.013.

5. Dawson L. P., Hare J., Duffy S. J. Myopericarditis with preserved left ventricular function secondary to Neisseria meningitidis, Diagnostic Microbiology and Infectious Disease. 2018; 3 (92): 241-244. https://doi.org/10.1016/j.diagmicrobio.2018.06.006.

6. Taldir G., Parize P., Arvis P., Faisy C. Acute right-sided heart failure caused by Neisseria meningitidis. J Clin Microbiol. 2013; 51 (1): 363-365. DOI: 10.1128/JCM.02264-12. Epub 2012 Oct 31. PMID: 23115261; PMCID: PMC3536187.

7. Baevsky R. H. Primary meningococcal pericarditis. Clin Infect Dis. 1999; 29 (1): 213-215. DOI: 10.1086/520165. PMID: 10433596.

8. Zeidan A., Tariq S., Faltas B., Urban M., McGrody K. A case of primary meningococcal pericarditis caused by Neisseria meningitidis serotype Y with rapid evolution into cardiac tamponade. J Gen Intern Med. 2008; 23 (9): 1532-1535. DOI: 10.1007/s11606-008-0685-y. Epub 2008 Jun 12. PMID: 18548315; PMCID: PMC2517992.

9. Mirón L., Neyro S., Cheistwer A., Muracciole B., Ortellao G., Martínez Iriart E. Pericarditis como presentación inicial de enfermedad meningocócica diseminada [Pericarditis as initial presentation of disseminated meningococcal disease]. Arch Argent Pediatr. 2013; 111 (6): e144-147. Spanish. DOI: 10.5546/aap.2013.e144. PMID: 24196773.

10. Keeley A. J., Hammersley D., Dhamrait S. S. A case of myopericarditis caused by Neisseria meningitidis W135 serogroup with protracted inflammatory syndrome. Clin Med (Lond). 2018; 18 (3): 253-255. DOI: 10.7861/clinmedicine.18-3-253. PMID: 29858438; PMCID: PMC6334081.

11. Bolduzeva S. A., Churina M. V., Tsyrulnikova A. N., Malaeva E. G. Cardiac tamponade. Meditsinskie novosti. 2020; 11 (314). URL: https://cyberleninka.ru/article/n/tamponada-serdtsa. (In Russ.)

12. Aung M., Raith E., Williams E., Burrell A. J. Severe meningococcal serogroup W sepsis presenting as myocarditis: A case report and review of literature. J Intensive Care Soc. 2019; 20 (2): 182-186. DOI: 10.1177/1751143718794127. Epub 2018 Sep 10.

13. Lin V. H., Parekh R. S., McQuillan M. A., Braun D. K., Markovitz D. M. Meningococcal Endocarditis Presenting as Cellulitis. Clinical Infectious Diseases. 1995; 21 (4): 1023-1025. DOI: 10.1093/clinids/21.4.1023.

14. Gunn J., Gaw A., Trueman A. M. A case of meningococcal endocarditis. Eur Heart J. 1992; 13: 1004-1005.

15. Ali M., McAdam B. Neisseria meningitidis endocarditis: A case report and review of the literature. Scandinavian Journal of Infectious Diseases. 2011; 43 (9), 747-749. DOI: 10.3109/00365548.2011.572910.

16. Arias I. M., Henning T. D., Alba L. M., Rubio S. A meningococcal endocarditis in a patient with Sweet’ s syndrome. Int J Cardiol. 2007; 117: e51-52.

17. Benes J., Dzupova O., Kabelkova M., Krizova P., Gabrielova A. Infective endocarditis due to Neisseria meningitidis: two case reports. Clin Microbiol Infect. 2003; 9: 1062-1064.

18. Joao I., Marques P., Namora J., Aguas M. J., Rosario L., Carvalho A., et al. Neisseria meningitidis native valve endocarditis. A case report. Rev Port Cardiol. 2001; 20: 877-880.

19. Borba M. G., Oliveira M. C., João G. A., Fernandes M., Silva F. M., Fragoso S., Silva E. C., Cordeiro-Santos M. Invasive meningococcal disease with pericarditis and pneumonia: A rare presentation in childhood. IDCases. 2016; 4: 41-42. DOI: 10.1016/j.idcr.2016.01.005. PMID: 27077027; PMCID: PMC4816901.

20. Green M., Harrison P., Sengupta A., Schlosshan D. A case report of primary meningococcal pericarditis secondary to Neisseria meningitidis in a young female patient. IDCases. 2022; 30: e01634. DOI: 10.1016/j.idcr.2022.e01634. PMID: 36353701; PMCID: PMC9637883.

21. Ramsdale D. R., Kaul T. K., Coulshed N. Primary meningococcal pericarditis with tamponade. Postgrad Med J. 1985; 61 (722): 1067-1068. DOI: 10.1136/pgmj.61.722.1067. PMID: 4095050; PMCID: PMC2418524.

22. Jones C. Pericarditis complicating a case of meningococcal meningitis. Br Heart J. 1977; 39 (1): 107-109. DOI: 10.1136/hrt.39.1.107. PMID: 831732; PMCID: PMC483201.

23. Akinosoglou K., Alexopoulos A., Koutsogiannis N., Gogos C., Lekkou A. Neisseria meningitidis presenting as acute abdomen and recurrent reactive pericarditis. Braz J Infect Dis. 2016; 20 (6): 641-644. DOI: 10.1016/j.bjid.2016.08.005. Epub 2016 Sep 12. PMID: 27631124; PMCID: PMC9427643.

24. Hardy D. J., Bartholomew W. R., Amsterdam D. Pathophysiology of primary meningococcal pericarditis associated with neisseria meningitidis group C. A case report and review of the literature. Diagn Microbiol Infect Dis. 1986; 4: 259-265.

25. De Souza A. L., Marques Salgado M., Romano C. C., et al. Cytokine activation in purulent pericarditis caused by neisseria meningitidis serogroup C. Int J Cardiol. 2006; 113: 419-421.

26. Thiru Y., Pathan N., Bignall S., Habibi P., Levin M. A myocardial cytotoxic process is involved in the cardiac dysfunction of meningococcal septic shock. Crit Care Med. 2000; 28: 2979-2983. DOI: 10.1097/00003246-200008000-00049.

27. Monsalve F., Rucabado L., Salvador A., Bonastre J., Cuñat J., Ruano M. Myocardial depression in septic shock caused by meningococcal infection. Crit Care Med. 1984; 12: 1021-1023. DOI: 10.1097/00003246-198412000-00003.

28. Pathan N., Hemingway C. A., Alizadeh A. A., Stephens A. C., Boldrick J. C., Oragui E. E., et al. Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet Lond Engl. 2004; 363: 203-209. DOI: 10.1016/S0140-6736(03)15326-3.

29. Makwana N., Baines P. B. Myocardial dysfunction in meningococcal septic shock. Curr Opin Crit Care. 2005; 11: 418-423. DOI: 10.1097/01.ccx.0000176699.51456.13.

30. Briassoulis G., Narlioglou M., Zavras N., Hatzis T. Myocardial injury in meningococcus-induced purpura fulminans in children. Intensive Care Med. 2001; 27: 1073-1082. DOI: 10.1007/s001340100957.

31. Shapira M. Y., Hirshberg B., Ben-Yehuda A. Asymptomatic temporary atrioventricular dissociation complicating meningococcal meningitis. Int J Cardiol. 1997; 62: 277-278.

32. Van Deuren M., Brandtzaeg P., van der Meer J. W. Update on meningococcal disease with emphasis on pathogenesis and clinical management. Clin Microbiol Rev. 2000; 13 (1): 144-166, table of contents. DOI: 10.1128/ CMR.13.1.144. PMID: 10627495; PMCID: PMC88937.

33. Guarner J., Greer P. W., Whitney A., Shieh W.-J., Fischer M., White E. H., et al. Pathogenesis and diagnosis of human meningococcal disease using immunohistochemical and PCR assays. Am J Clin Pathol. 2004; 122: 754-764. DOI: 10.1309/3489075U03LMK9AE.