A 17-year-old develops Neisseria meningitidis meningitis. What was the first event?

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Neisseria meningitidis is transmitted by direct oral mucosal contact or direct receipt of infected respiratory droplets on another's oropharyngeal mucosa. Nm adheres via pili and other adhesins; additionally, IgA-protease production and the capsule allow survival in a non-immune individual, allowing upper respiratory colonization that is followed by invasion of the bloodstream. This precedes development of pneumonia or meningitis. Skin lesions develop from overproduction of outer membrane, which is excreted without being incorporated, causing endotoxic shock and petechiae that progress to frank purpura. Waterhouse-Friderichsen syndrome is late.

A 17-Year-Old Develops Neisseria Meningitidis Meningitis