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Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia

Parmentier, Laurent
Published in Archives of Dermatology. 2008, vol. 144, no. 6, p. 770-3
Abstract BACKGROUND: Chronic meningococcemia (CM) is a diagnostic challenge. Skin lesions are frequent but in most cases nonspecific. Polymerase chain reaction (PCR)-based diagnosis has been validated in blood and cerebrospinal fluid for acute Neisseria meningitidis infection, in patients in whom routine microbiologic tests have failed to isolate the bacteria. In 2 patients with CM, we established the diagnosis by a newly developed PCR-based approach performed on skin biopsy specimens. OBSERVATIONS: Two patients presented with fever together with systemic and cutaneous manifestations suggestive of CM. Although findings from blood cultures remained negative, we were able to identify N meningitidis in the skin lesions by a newly developed PCR assay. In 1 patient, an N meningitidis strain of the same serogroup was also isolated from a throat swab specimen. Both patients rapidly improved after appropriate antibiotherapy. CONCLUSIONS: To our knowledge, we report the first cases of CM diagnosed by PCR testing on skin biopsy specimens. It is noteworthy that, although N meningitidis-specific PCR is highly sensitive in blood and cerebrospinal fluid in acute infections, our observations underscore the usefulness of PCR performed on skin lesions for the diagnosis of chronic N meningitidis infections. Whenever possible, this approach should be systematically employed in patients for whom N meningitidis infection cannot be confirmed by routine microbiologic investigations.
Keywords AdolescentAdultBacteremia/diagnosis/etiologyBiopsyChronic DiseaseDNA, Bacterial/analysisDiagnosis, DifferentialHumansMaleMeningococcal Infections/diagnosis/microbiologyNeisseria meningitidis/genetics/isolation & purificationPolymerase Chain Reaction/methodsSkin/microbiology/pathologySkin Diseases, Bacterial/complications/diagnosis/microbiology
PMID: 18559767
Note Erratum in: Arch Dermatol. 2008 Sep;144(9):1182.
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Other version: http://archderm.ama-assn.org/cgi/content/full/144/6/770
Research group Groupe Laurent Kaiser (virologie clinique) (668)
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PARMENTIER, Laurent et al. Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia. In: Archives of Dermatology, 2008, vol. 144, n° 6, p. 770-3. https://archive-ouverte.unige.ch/unige:2435

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Deposited on : 2009-08-13

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