Wednesday, March 12, 2008
A white male U.S. citizen, aged 58 years, returning from a 2-month stay in China was hospitalized on November 8, 2006, with Gram-negative diplococci septicemia and died <48 hours after admission. Final blood culture yielded Neisseria gonorrhoeae.
Describe a fatal case of disseminated gonococcal infection (DGI).
Review of hospital records and patient's travel Internet log; and discussion with family, social contacts, and Chinese health authorities.
One week before returning to the U.S, the patient experienced nausea, vomiting, and diarrhea, which he attributed to foodborne illness. A Chinese health-care provider reportedly prescribed herbal medication and encouraged further evaluation in the U.S. The patient's condition worsened on the airplane; he was evaluated by U.S. quarantine personnel upon arrival and transferred by ambulance to a hospital. Noteworthy medical history included diabetes mellitus, chronic hepatitis C, and cirrhosis. On admission, the patient was hypotensive, hypoxemic, and hypothermic. Physical examination revealed jaundice, dyspnea, diffuse abdominal tenderness, and edematous extremities with ecchymoses. Laboratory tests revealed leukocytosis, coagulopathy, metabolic acidosis, and azotemia. Diagnoses included sepsis and multiorgan failure, attributed to Neisseria meningitidis, after a blood culture yielded Gram-negative diplococci. Despite intubation and broad-spectrum antimicrobials, his condition deteriorated; he died within 48 hours. The isolate, later confirmed by real-time polymerase chain reaction as N. gonorrhoeae, was resistant to ciprofloxacin and tetracycline. His wife, the only known sexual contact within the previous 6 months, tested negative for N. gonorrhoeae. Social history during his stay in China was unavailable. No additional DGI cases were reported by Chinese health authorities.
The degree to which host factors, microbial virulence factors, and delay in treatment influenced the patient's death is uncertain. Although death resulting from gonorrhea is rare, clinicians should be aware of signs and symptoms of DGI.
Further research is needed to characterize risk factors associated with DGI and death from DGI.