The CSF culture was without growth. The patient initially required inotropic support. On his third hospital day he underwent knee arthrocentesis, and the synovial fluid culture was negative. Discharge to home occurred on the fifth hospital day. The upper respiratory tract of humans is the only known reservoir of Neisseria meningitidis with transmission from person to person by the respiratory route through pharyngeal secretions.
Asymptomatic carriers are presumably the major source of transmission of pathogenic strains.
Meningitis is the most common presentation but meningococcal septicemia, also called meningococcemia, is the most devastating form of meningococcal disease with a high mortality rate. The diagnosis of meningococcemia is confirmed by positive blood culture. Because of asyniptomatic carnage, a diagnosis cannot be made solely from a positive nasopharyngeal culture. My thanks to Drs. Sandy Ro-Yim and Russ Johnson for their assistance in the presentation of this case.