Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2019; 7(5): 636-641
Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.636
Fatal meningococcal meningitis in a 2-year-old child: A case report
Aleksander Mularski, Czesław Żaba
Aleksander Mularski, Department of Legal and Forensic Medicine, Poznan University of Medical Sciences, Poznan 60-781, Poland
Czesław Żaba, Institute of Forensic Research, Cracow 31-033, Poland
Author contributions: Mularski A and Żaba C performed the postmortem examination, reviewed the literature and contributed to manuscript drafting.
Informed consent statement: No informed written consent was needed as the medicolegal autopsy was carried out at a prosecutor’s request.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Aleksander Mularski, MD, Academic Fellow, Medical Assistant, Department of Legal and Forensic Medicine, Poznan University of Medical Sciences, Święcickiego 6, Poznan 60-781, Poland.
Telephone: +48-61-8546410 Fax: +48-61-8546410
Received: December 20, 2018
Peer-review started: December 20, 2018
First decision: January 5, 2019
Revised: January 14, 2019
Accepted: January 29, 2019
Article in press: January 30, 2019
Published online: March 6, 2019

In fatal cases of meningococcal septicemia, bacteriological diagnosis may not be straightforward due to postmortem replication and relocation of endogenic microflora. In medicolegal practice, aside from routine autopsy and histopathology, also other diagnostic methods, such as microbiological tests, immunohistochemistry and polymerase chain reaction (PCR), are used to examine body fluids and tissues.


We present the case of sudden death in a 2-year-old child. The patient died approximately 30 min after hospital admission before any routine diagnostic procedures were undertaken. Presence of whole-body rash and fulminant course of the disease raised suspicion of meningococcal septicemia. An autopsy was performed seven days after death when the body showed the signs of late postmortem decomposition. No etiological factor of septicemia could be identified based on macro- and microscopic findings. However, PCR demonstrated the presence of genetic material of group W Neisseria meningitidis in patient’s cerebrospinal fluid and blood.


Microbiological PCR should be conducted postmortem whenever a specific etiological factor could not be identified with conventional methods.

Keywords: Meningococcal infection, Molecular microbiology, Waterhouse-Friderichsen syndrome, Neisseria meningitidis, Autopsy, Cerebrospinal fluid, Case report

Core tip: We present the case of a 2-year-old patient who died suddenly with the signs of meningococcal septicemia. No etiological factor of the septicemia could be identified based on macro- and microscopic findings during an autopsy carried out seven days postmortem. However, the genetic material of group W Neisseria meningitidis was detected in cerebrospinal fluid samples based on polymerase chain reaciton (PCR). Our observations imply that microbiological PCR can be helpful in medicolegal practice, especially when an autopsy is delayed and the results of conventional bacteriological examination are unavailable or seem controversial.