Neonatal invasive meningococcal disease: Clinical case from Saudi Arabia and updated review of reported cases

Neonatal invasive meningococcal disease (IMD) is rare but associated with severe morbidity and mortality. We report an 11-day-old male neonate who presented with fever, apnea, and poor feeding and was diagnosed with meningitis due to Neisseria meningitidis. Diagnosis was confirmed by blood culture and cerebrospinal fluid (CSF) multiplex PCR, although CSF culture remained negative. The patient developed ventriculitis, requiring prolonged antimicrobial therapy. To contextualize this case, we reviewed 71 previously reported neonatal IMD cases published between 1916 and 2024. The present case is discussed alongside these reports for comparison. Among the 54 cases with reported clinical symptoms, fever (31/54, 57.4%) and irritability (23/54, 42.6%) were the most frequent clinical signs, while petechiae were documented in 12/54 cases (22.2%). Serogroup B predominated among cases with available serogroup data (23/39, 59.0%). Among the 71 previously reported cases, mortality occurred in 22/71 cases (31.0%), while hydrocephalus (8/71, 11.3%) and seizures (7/71, 9.9%) were the most frequently reported complications. This case highlights diagnostic challenges in neonatal IMD, particularly in culture-negative disease, and underscores the importance of molecular diagnostics. Preventive strategies such as improved serogroup surveillance may reduce IMD burden in neonates, maternal immunization remains investigational.