{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T17:00:43Z","timestamp":1772643643943,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Pfizer Inc."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Laboratory confirmation of invasive meningococcal disease (IMD) relies on detection of Neisseria meningitidis in a biological specimen. Clinical management guidelines for patients presenting with signs and\/or symptoms of meningitis and encephalitis emphasize the need for appropriate specimen collection for laboratory testing. To explore the potential for IMD under-diagnosis, we reviewed medical records of patients admitted with signs and\/or symptoms of meningitis or encephalitis at five hospitals in Louisville, Kentucky, in 2014 to 2023. Among 675 patients admitted with meningitis and\/or encephalitis with cerebrospinal fluid (CSF) cultures who received antibiotics, 300 (44.4%) received antibiotics before CSF collection. Among 431 with blood cultures who received antibiotics, 133 (30.9%) received antibiotics before blood collection. Among 751 patients with CSF collected, 651 (86.7%) CSF specimens were tested using polymerase chain reaction (PCR) for N. meningitidis detection. No blood specimens were PCR-tested. These findings indicated that current standard-of-care practices may lead to IMD under-diagnosis. Since public health surveillance relies on IMD laboratory diagnosis, these findings highlight the potential for under-ascertained IMD by surveillance.<\/jats:p>","DOI":"10.3390\/pathogens14100962","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T08:19:45Z","timestamp":1758701985000},"page":"962","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Ten-Year Retrospective Review of Medical Records of Patients Admitted with Meningitis or Encephalitis at Five Hospitals in the United States Highlights the Potential for Under-Ascertainment of Invasive Meningococcal Disease"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-5374","authenticated-orcid":false,"given":"Julio","family":"Ramirez","sequence":"first","affiliation":[{"name":"Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY 40203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9112-2860","authenticated-orcid":false,"given":"Stephen","family":"Furmanek","sequence":"additional","affiliation":[{"name":"Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY 40203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2284-6213","authenticated-orcid":false,"given":"Thomas","family":"Chandler","sequence":"additional","affiliation":[{"name":"Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY 40203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josue","family":"Prado","sequence":"additional","affiliation":[{"name":"Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY 40203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5866-7295","authenticated-orcid":false,"given":"Lisa R.","family":"Harper","sequence":"additional","affiliation":[{"name":"Global Vaccines Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Shen","sequence":"additional","affiliation":[{"name":"Global Vaccines Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2101-2476","authenticated-orcid":false,"given":"Raffaella","family":"Iantomasi","sequence":"additional","affiliation":[{"name":"Global Vaccines Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-8980","authenticated-orcid":false,"given":"Jessica V.","family":"Presa","sequence":"additional","affiliation":[{"name":"Global Vaccines Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Ali","sequence":"additional","affiliation":[{"name":"Evidence Generation and Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5153-4043","authenticated-orcid":false,"given":"Jamie","family":"Findlow","sequence":"additional","affiliation":[{"name":"Global Vaccines Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer C.","family":"Mo\u00efsi","sequence":"additional","affiliation":[{"name":"Global Vaccines Medical Affairs, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3120-7704","authenticated-orcid":false,"given":"Frederick J.","family":"Angulo","sequence":"additional","affiliation":[{"name":"Medical Evidence Group, Pfizer, Collegeville, PA 19426, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11910-015-0524-6","article-title":"Invasive meningococcal disease in the 21st century\u2014An update for the clinician","volume":"15","author":"Dwilow","year":"2015","journal-title":"Curr. 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