Primary meningococcal arthritis

Clinical manifestations, diagnostic studies and management of primary meningococcal arthritis were reviewed in six children from Dallas and in 19 pediatric and adult patients from the literature. This entity is a rare form of meningococcal infection which presents as acute septic arthritis without meningitis or the classical clinical syndrome of meningococcemia. Primary meningococcal arthritis follows the well known age-specific attack rate of meningococcal disease. Polyarthritic involvement, mainly of large joints, in about one-third of the patients represents a distinct difference from acute arthritis due to other bacteria with the exception of Neisseria gonorrhoeae. Neisseria meningitidis is cultured from the purulent synovial fluid in 80% to 90%, from the blood in approximately 40%, and from the throat in approximately 30%. The response to adequate antimicrobial therapy is somewhat slow and evacuation of pus should probably be performed. The prognosis of primary suppurative meningococcal arthritis is excellent. Meningococcal complications involving other organs and joint residua are rarely seen.