Seven-week interval between acquisition of a meningococcus and the onset of invasive disease. A case report.

Invasive meningococcal disease (IMD) is thought to occur within a few days of pharyngeal acquisition of Neisseria meningitidis. During a longitudinal study of carriage and acquisition among 2453 first-year undergraduates we identified a male student from whom N. lactamica was isolated in October 1997 followed by N. meningitidis in December 1997. In mid-January 1998 this student suffered a mild episode of IMD (meningitis) during which N. meningitidis was isolated from his CSF. The meningococcus carried in December 1997 was phenotypically and genotypically indistinguishable from the invading organism, suggesting the possibility that the organism may have been carried for 7 weeks prior to the onset of invasive disease. Further studies are needed to assess more accurately the range of asymptomatic carriage prior to disease onset.