Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Diagnosis of meningococcal infection

Michael Apicella, MD
Section Editors
Stephen B Calderwood, MD
Morven S Edwards, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Neisseria meningitidis is the second most common cause of community-acquired adult bacterial meningitis in the United States [1]. Since routine vaccination of infants with the Haemophilus influenzae type b capsular conjugate vaccine was introduced, N. meningitidis has become the leading cause of bacterial meningitis in children and adolescents in the United States. (See "Bacterial meningitis in children older than one month: Clinical features and diagnosis", section on 'Causative organisms'.)

The clinical manifestations of meningococcal disease can be quite varied, ranging from transient fever and bacteremia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. (See "Clinical manifestations of meningococcal infection".)

The diagnosis of meningococcal infection will be reviewed here [2-4]. The gold standard for the diagnosis of systemic meningococcal infection is the isolation of N. meningitidis from a usually sterile body fluid, such as blood or cerebrospinal fluid, or, less commonly, synovial, pleural, or pericardial fluid.

The microbiology, pathogenesis, epidemiology, treatment, and prevention of N. meningitidis infection are discussed separately. (See "Microbiology and pathobiology of Neisseria meningitidis" and "Epidemiology of Neisseria meningitidis infection" and "Treatment and prevention of meningococcal infection".)


It is important to isolate the organism not only to confirm an etiology of infection but also to perform antibiotic susceptibility testing. Meningococci with increasing resistance to the penicillins, chloramphenicol, and cephalosporins have been reported [5-10].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011; 364:2016.
  2. Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med 2001; 344:1378.
  3. Gardner P. Clinical practice. Prevention of meningococcal disease. N Engl J Med 2006; 355:1466.
  4. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007; 369:2196.
  5. Angyo IA, Okpeh ES. Changing patterns of antibiotic sensitivity and resistance during an outbreak of meningococcal infection in Jos, Nigeria. J Trop Pediatr 1998; 44:263.
  6. Galimand M, Gerbaud G, Guibourdenche M, et al. High-level chloramphenicol resistance in Neisseria meningitidis. N Engl J Med 1998; 339:868.
  7. Sprott MS, Kearns AM, Field JM. Penicillin-insensitive Neisseria meningitidis. Lancet 1988; 1:1167.
  8. Mendelman PM, Campos J, Chaffin DO, et al. Relative penicillin G resistance in Neisseria meningitidis and reduced affinity of penicillin-binding protein 3. Antimicrob Agents Chemother 1988; 32:706.
  9. Sáez-Nieto JA, Lujan R, Berrón S, et al. Epidemiology and molecular basis of penicillin-resistant Neisseria meningitidis in Spain: a 5-year history (1985-1989). Clin Infect Dis 1992; 14:394.
  10. Fangio P, Desbouchages L, Lachérade JC, et al. Neisseria meningitidis C:2b:P1.2,5 with decreased susceptibility to penicillin isolated from a patient with meningitis and purpura fulminans. Eur J Clin Microbiol Infect Dis 2005; 24:140.
  11. HOYNE AL, BROWN RH. Seven hundred and twenty seven meningococcic cases; an analysis. Ann Intern Med 1948; 28:248.
  12. TOBIN JL. Complications of meningococcus infection in a series of sixty-three consecutive sporadic cases. Am J Med Sci 1956; 231:241.
  13. McCracken GH Jr. Rapid identification of specific etiology in meningitis. J Pediatr 1976; 88:706.
  14. CARPENTER RR, PETERSDORF RG. The clinical spectrum of bacterial meningitis. Am J Med 1962; 33:262.
  15. Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 1993; 328:21.
  16. Levin S, Painter MB. The treatment of acute meningococcal infection in adults. A reappraisal. Ann Intern Med 1966; 64:1049.
  17. Finlay FO, Witherow H, Rudd PT. Latex agglutination testing in bacterial meningitis. Arch Dis Child 1995; 73:160.
  18. Feldman WE. Relation of concentrations of bacteria and bacterial antigen in cerebrospinal fluid to prognosis in patients with bacterial meningitis. N Engl J Med 1977; 296:433.
  19. Tunkel AR, van de Beek D, Scheld WM. Acute meningitis. In: Principles and Practice of Infectious Diseases, 7th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2010. p.1189.
  20. Bohr V, Rasmussen N, Hansen B, et al. 875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series. J Infect 1983; 7:193.
  21. Kanegaye JT, Soliemanzadeh P, Bradley JS. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Pediatrics 2001; 108:1169.
  22. Bryant PA, Li HY, Zaia A, et al. Prospective study of a real-time PCR that is highly sensitive, specific, and clinically useful for diagnosis of meningococcal disease in children. J Clin Microbiol 2004; 42:2919.
  23. Arend SM, Lavrijsen AP, Kuijken I, et al. Prospective controlled study of the diagnostic value of skin biopsy in patients with presumed meningococcal disease. Eur J Clin Microbiol Infect Dis 2006; 25:643.
  24. Muller PD, Donald PR, Burger PJ, van der Horst W. Detection of bacterial antigens in cerebrospinal fluid by a latex agglutination test in 'septic unknown' meningitis and serogroup B meningococcal meningitis. S Afr Med J 1989; 76:214.
  25. Borel T, Rose AM, Guillerm M, et al. High sensitivity and specificity of the Pastorex latex agglutination test for Neisseria meningitidis serogroup A during a clinical trial in Niger. Trans R Soc Trop Med Hyg 2006; 100:964.
  26. McGraw TP, Bruckner DA. Evaluation of the Directigen and Phadebact agglutination tests. Am J Clin Pathol 1984; 82:97.
  27. Hayden RT, Frenkel LD. More laboratory testing: greater cost but not necessarily better. Pediatr Infect Dis J 2000; 19:290.
  28. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267.
  29. Ni H, Knight AI, Cartwright K, et al. Polymerase chain reaction for diagnosis of meningococcal meningitis. Lancet 1992; 340:1432.
  30. Newcombe J, Cartwright K, Palmer WH, McFadden J. PCR of peripheral blood for diagnosis of meningococcal disease. J Clin Microbiol 1996; 34:1637.
  31. Borrow R, Claus H, Chaudhry U, et al. siaD PCR ELISA for confirmation and identification of serogroup Y and W135 meningococcal infections. FEMS Microbiol Lett 1998; 159:209.
  32. Speers DJ, Jelfs J. Typing of Neisseria meningitidis by restriction analysis of the amplified porA gene. Pathology 1997; 29:201.
  33. Newcombe J, Dyer S, Blackman L, et al. PCR-single-stranded confirmational polymorphism analysis for non-culture-based subtyping of meningococcal strains in clinical specimens. J Clin Microbiol 1997; 35:1809.
  34. Diggle MA, Clarke SC. Detection and genotyping of meningococci using a nested PCR approach. J Med Microbiol 2003; 52:51.
  35. Diggle MA, Clarke SC. Molecular methods for the detection and characterization of Neisseria meningitidis. Expert Rev Mol Diagn 2006; 6:79.
  36. Meningococcal Reference Unit, Gray SJ, Trotter CL, et al. Epidemiology of meningococcal disease in England and Wales 1993/94 to 2003/04: contribution and experiences of the Meningococcal Reference Unit. J Med Microbiol 2006; 55:887.
  37. Corless CE, Guiver M, Borrow R, et al. Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol 2001; 39:1553.
  38. Darton T, Guiver M, Naylor S, et al. Severity of meningococcal disease associated with genomic bacterial load. Clin Infect Dis 2009; 48:587.
  39. Onyango CO, Loparev V, Lidechi S, et al. Evaluation of a TaqMan Array Card for Detection of Central Nervous System Infections. J Clin Microbiol 2017; 55:2035.
  40. Kodani M, Yang G, Conklin LM, et al. Application of TaqMan low-density arrays for simultaneous detection of multiple respiratory pathogens. J Clin Microbiol 2011; 49:2175.
  41. Patel JC, George J, Vuong J, et al. Rapid Laboratory Identification of Neisseria meningitidis Serogroup C as the Cause of an Outbreak - Liberia, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1144.
  42. Cavrini F, Liguori G, Andreoli A, Sambri V. Multiple nucleotide substitutions in the Neisseria meningitidis serogroup C ctrA gene cause false-negative detection by real-time PCR. J Clin Microbiol 2010; 48:3016.
  43. Jaton K, Ninet B, Bille J, Greub G. False-negative PCR result due to gene polymorphism: the example of Neisseria meningitidis. J Clin Microbiol 2010; 48:4590.
  44. Collard JM, Wang X, Mahamane AE, et al. A five-year field assessment of rapid diagnostic tests for meningococcal meningitis in Niger by using the combination of conventional and real-time PCR assays as a gold standard. Trans R Soc Trop Med Hyg 2014; 108:6.
  45. Bourke TW, Fairley DJ, McKenna JP, et al. Clinical Evaluation of Streptococcus pneumoniae Polymerase Chain Reaction in Children with Suspected Septicemia. Pediatr Infect Dis J 2015; 34:1276.
  46. Notomi T, Okayama H, Masubuchi H, et al. Loop-mediated isothermal amplification of DNA. Nucleic Acids Res 2000; 28:E63.
  47. Lee D, Kim EJ, Kilgore PE, et al. Clinical evaluation of a loop-mediated isothermal amplification (LAMP) assay for rapid detection of Neisseria meningitidis in cerebrospinal fluid. PLoS One 2015; 10:e0122922.
  48. Lee D, Kim EJ, Kilgore PE, et al. A Novel Loop-Mediated Isothermal Amplification Assay for Serogroup Identification of Neisseria meningitidis in Cerebrospinal Fluid. Front Microbiol 2015; 6:1548.