An analysis of Neisseria meningitidis strains causing meningococcal septic arthritis in England and Wales: 2010-2020

Objectives: To analyze clinical meningococcal strains associated with meningococcal septic arthritis cases in England and Wales, and to identify associations between patient age, the synovial joint affected and strain characteristics. Methods: IMD cases confirmed by the Meningococcal Reference Unit (UK Health Security Agency) between January 2010 and December 2020 were included in the analysis. Septic arthritis cases were defined as those featuring detection and/or isolation of N. meningitidis from an articular site. Capsular grouping was performed by serology on clinical isolates and/or real-time PCR on clinical samples. Results: We identified 162 cases of meningococcal septic arthritis, representing 2% of all invasive meningococcal disease cases during the study period. The knee and the hip were the most commonly affected joints, with the former significantly more frequent in adults and the latter seen more commonly in children and adolescents. Group B strains were between 2 and 6 times less likely to cause septic arthritis in relation to groups W, C and Y strains. Conclusions: Meningococcal septic arthritis remains a rare manifestation of invasive meningococcal disease. Strain and age associations identified in this study remain unexplained. Future analyzes including clinical case information may help to explain these findings. Crown Copyright (C) 2022 Published by Elsevier Ltd on behalf of The British Infection Association.

Automated summary

This study analyzed clinical meningococcal strains associated with meningococcal septic arthritis cases in England and Wales, and identified associations between patient age, the synovial joint affected, and strain characteristics. The knee and the hip were the most commonly affected joints, and different strains had varying likelihoods of causing septic arthritis.