Humans are the only known reservoir for Neisseria meningitidis.
Meningococcal infection begins in the nasopharynx.
Shortly after adherence to the nasopharyngeal mucosa, encapsulated meningococci are transported through nonciliated epithelial cells in large, membrane phagocytic vacuoles. Within 24 hours, the microorganisms are observed in the submucosa in close proximity to blood vessels. Although meningococcal infection is generally a bacteremic disease, N. meningitidis exhibits a marked affinity for the meninges and skin and to a lesser degree for synovia, serosal surfaces, and adrenal glands. The most common presentation is thus a composite of bacteremia and meningitis. A hallmark of meningococcemia is the appearance of a petechial rash .