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Meningitis caused by Neisseria meningitides

N meningitides is a gram-negative diplococcus that is carried in the nasopharynx of otherwise healthy individuals. It initiates invasion by penetrating the airway epithelial surface. The precise mechanism by which this occurs is unclear, but recent viral or mycoplasmal infection has been reported to disrupt the epithelial surface and facilitate invasion by meningococcus. Most sporadic cases (95-97%) are caused by serogroups B, C, and Y, while the A and C strains are observed in epidemics (< 3% of cases). Currently, it is the leading cause of bacterial meningitis in children and young adults, accounting for 59% of cases.

Risk factors for Neisseria meningitis include the following:

• Deficiencies in terminal complement components (eg, membrane attack complex, C5-C9), which increases attack rates but is associated with surprisingly lower mortality rates
• Properdin defects that increase the risk of invasive disease
• Antecedent viral infection, household crowding, chronic medical illness, corticosteroid use, and active or passive smoking
• Overcrowding, as is observed in college dormitories (college freshmen living in dormitories are at highest risk) and military facilities, which has been reported for a clustering of cases

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