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May 28, 1982

Neisseria meningitidis Serogroup W135 Disease

JAMA. 1982;247(20):2779. doi:10.1001/jama.1982.03320450017011

To the Editor.—  The correct number of Neisseria meningitidis serogroup W135 cases referenced by Brandstetter et al (1981;246:2060) was 20, not 18. Three more cases of septic arthritis1-3 and one case of fatal meningitis (1981; 246:1119) were caused by this serogroup. One patient with septic arthritis had systemic lupus erythematosus, and the patient with fatal meningitis had a splenectomy after trauma.Invasive disease without a typical petechial rash was previously speculated to be more characteristic of N meningitidis serogroup W135.1 A petechial rash was noted in only four (17%) of 24 cases with published clinical characteristics. This contrasts markedly to generalized macular, petechial, or purpuric skin lesions reported in 86% of 151 patients with the meningococcal infection described before most serogroup W135 cases.Development of meningitis, disseminated intravascular coagulation, or both in 16 (67%) of 24 cases indicates that factors other than organism virulence cause the relative rarity