Primary meningococcal conjunctivitis: Looking beyond the conjunctiva

Background: Neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis. However, its diagnosis has important therapeutic implications. Methods: From December 1993 to January 1984, a prospective study on acute bacterial conjunctivitis was performed at the Hospital Universitario Materno-Infantil Vall d'Hebron. Primary meningococcal conjunctivitis (PMC) was diagnosed in 34 patients. The diagnosis of PMC was made on the basis of consistent clinical manifestations together with isolation of Neisseria meningitidis from conjunctival exudate culture. Results: There were 16 men and 18 women with a mean age of 3.5 ± 3.3 years. PMC was bilateral in 7 patients and unilateral in 27. Initial therapy for PMC included only topical antibiotics in 24 patients and systemic antibiotic therapy in 10. Ten patients (29.4%) developed invasive meningococcal disease. None of the patients died or developed ocular sequelae. Forty one percent of the patients who received only topical therapy and one of those who received systemic therapy, developed invasive meningococcal disease (p = 0.04). Conclusions: PMC may represent the portal of entry for invasive meningococcal disease, which occurs in almost a third of patients. Patients with PMC and higher risk of developing invasive meningococcal disease are those treated only with topical antibiotic therapy.