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Neonatal meningococcal disease

A male infant was born at 39 weeks gestation after an uneventful pregnancy and normal vaginal delivery. On day 7 of age, 1 day following a gathering with over 100 guests for his naming ceremony, he developed a non-blanching rash, poor feeding and fever. At presentation to the Emergency Department, he was lethargic with a purpuric rash and evidence of disseminated intravascular coagulopathy. He rapidly deteriorated, requiring intubation, multiple blood product transfusions and ventilatory and inotropic support. Neisseria meningitides serogroup B (PorA type P1.18-1,34) was isolated from blood culture collected on day 1 of illness. The infant developed necrotic lesions on his chin, scrotum and heels (Fig. 1), but his extremities remained viable. Following extubation, he had poor tone. Brain and skeletal MRI demonstrated mild myositis of the right quadriceps but otherwise normal appearances. He completed a 10-day course of antibiotic therapy, rationalised to benzyl penicillin on day 3. An extensive public health response was undertaken. The infant was discharged home at 18 days of age with subsequent normal neurodevelopmental and audiology follow-up at age 6 months. Terminal complement pathway testing performed at 3 months of age was normal.