BACKGROUND: Although Neisseria meningitidis is one of the major causes of meningitis, meningococcal pneumonia
is the most common non-neurological organ disease caused by this pathogen.
METHODS: We conducted a review of the literature to describe the risk factors, pathogenesis, clinical features,
diagnosis, treatment and prevention of meningococcal pneumonia.
RESULTS: Meningococcal pneumonia was first described in 1907 and during the 1918–1919 influenza pandemic
large numbers of cases of meningococcal pneumonia occurred in patients following the initial viral infection. A
number of publications, mainly case series or case reports, has subsequently appeared in the literature.
Meningococcal pneumonia occurs mainly with serogroups Y, W-135 and B. Risk factors for meningococcal
pneumonia have not been well characterised, but appear to include older age, smoking, people living in close
contact (e.g. military recruits and students at university), preceding viral and bacterial infections, haematological
malignancies, chronic respiratory conditions and various other non-communicable and primary and secondary
immunodeficiency diseases. Primary meningococcal pneumonia occurs in 5–10% of patients with meningococcal
infection and is indistinguishable clinically from pneumonia caused by other common pathogens. Fever, chills and
pleuritic chest pain are the most common symptoms, occurring in > 50% of cases. Productive sputum and
dyspnoea are less common. Diagnosis of meningococcal pneumonia may be made by the isolation of the
organism in sputum, blood, or normally sterile site cultures, but is likely to underestimate the frequency of
meningococcal pneumonia. If validated, PCR-based techniques may be of value for diagnosis in the future. While
penicillin was the treatment of choice for meningococcal infection, including pneumonia, prior to 1991, a third
generation cephalosporin has been more commonly used thereafter, because of concerns of penicillin resistance.
Chemoprophylaxis, using one of a number of antibiotics, has been recommended for close contacts of patients
with meningococcal meningitis, and similar benefits may be seen in contacts of patients with meningococcal
pneumonia. Effective vaccines are available for the prevention of infection with certain meningococcal serogroups,
but this field is still evolving.
CONCLUSION: Meningococcal pneumonia occurs fairly frequently and should be considered as a possible cause of
pneumonia, particularly in patients with specific risk factors.