Spectrum of Non-Suppurative Arthritis in Meningococcal infection in children: A Case Series

Introduction: Arthritis is a recognized manifestation of meningococcal infection and may occur due to either direct infective involvement or immune-mediated mechanisms, the latter being relatively uncommon.

Methodology: This case series included hospitalized patients aged ≤18 years diagnosed with meningococcal infection who developed joint involvement during the course of illness. Clinical presentation, pattern of joint involvement, laboratory findings, management, and outcomes were reviewed retrospectively from hospital records.

Aim and Objectives: To describe the clinical profile, pattern of joint involvement and outcomes of arthritis associated with meningococcal infection in children.

Results and observations: Out of total 110 cases, 7 (6.3%) had non-suppurative arthritis. Four (3.6%) in 1-5 years, 2 (1.8%) in 5-10 years and 1 (0.9%) in the age group of 10-18 years. Average age was 6.28 years. Sex ratio was male : female = 2.5:1. Bilateral knee joints were the most common joints to be involved, seen in 5 cases (71.4%). Other clinical presentations of the patients with arthritis – fever (100%), purpura (100%), rash (71.4%), headache (42.9%), meningeal signs (42.9%), altered sensorium (14.29%) and vomiting (14.29%). The seven cases with arthritis were proven by positive CSF culture in 2, petechial fluid culture in 1, positive gram stain of CSF in 1, and positive Gram stain of petechial fluid in 1 patient. USG of joints was done in all cases and was suggestive of mild to moderate effusion and synovial thickening of the involved joints. Average duration of hospital stay was 8.43 days. All 7 patients recovered without sequelae on subsequent follow up.

Conclusion: Prompt diagnosis and management will lead to healing without complications in most cases of non-suppurative arthritis associated with meningococcal infection.