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Gonococcemia

Disseminated Gonococcemia

Gonococcemia is the dissemination of gonorrhea infection to the bloodstream and other sites. The typical manifestations are a rash, polyarthralgia, and tenosynovitis.


Presentation

Gonorrhea is a sexually transmitted disease (STD) caused by N. gonorrhea, which can infect the genital tract, rectum, or pharynx. One complication of this STD is the spread of the bacterial pathogen to the blood and other sites. This is known as gonococcemia, which is also referred to as disseminated gonococcal infection. Disseminated disease affects up to 3% of individuals with gonorrhea [1] and develops within 2 to 3 weeks after a primary genital infection [2].

The clinical picture of gonococcemia will typically feature a rash, polyarthralgia, and tenosynovitis [3], although not all three have to be present for the diagnosis. Cutaneous manifestations are described below. The arthralgia encompasses numerous, asymmetrical joints and is typically associated with sterile culture from synovial fluid [4] [5]. Polyarthralgia and tenosynovitis more commonly involve the joints of the hands and feet such as wrists and ankles [6].

The risk factors for gonococcemia include the female gender, multiple sexual partners, pregnancy, menses, low socioeconomic status, intravenous drug use, HIV, hypocomplementemia, and systemic lupus erythematosus [7].

Complications

Meningitis [4], myocarditis [8], and hepatic abscess formation [9] are among the rare sequelae of gonococcemia.

Physical exam

The patient's vital signs are notable for a low-grade fever. With regards to the rash, the skin lesions are characterized as vesicular, maculopapular, pustular or vesicular and they appear on the limbs, palms, soles, and trunk [4]. Remarkable findings on the musculoskeletal exam include tenderness and erythema of the involved joints and tendon sheaths as well as limited range of motion.

Patients with gonococcal meningitis exhibit meningeal signs and mental status changes while those with gonococcal endocarditis develop tachycardia and a new murmur.

Fever
  • […] scarlet fever What causes a strawberry toungue? Describe the progression of this. Scarlet fever -starts white and then by day 5 turns red What is associated with "sandpaper" quality or "sunburn with goosebumps"? scarlet fever T or F.[quizlet.com]
  • Report of a Case A 26-year-old Negro man was admitted to USAF Hospital Andrews on May 5, 1965, for recurrent fever, polyarthralgia, and a skin eruption of nine weeks' duration.[jamanetwork.com]
  • Gonococcemia (also known as "Arthritis–dermatosis syndrome" [1] and "Disseminated gonococcal infection" [1] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis of one or several[en.wikipedia.org]
  • Frequently, these sparse, acral lesions occurring in young adults, especially women, who have fever, polyarthralgia, and tenosynovitis, are dismissed as folliculitis or regarded as manifestations of "flu," acute rheumatic fever or systemic lupus erythematosus[nejm.org]
Chills
  • Abstract A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees.[ncbi.nlm.nih.gov]
  • […] skip to main content column skip to left navigation skip to horizontal navigation Medical Mystery Quillen College of Medicine Medicalmystery Archive Last Weeks Mystery A 24-year-old previously healthy woman presents with a 2 day history of fever, chills[etsu.edu]
  • [Case Reports] Int J Dermatol 2003; 42(3):208-9 Mehrany K, Kist JM, … DiCaudo DJ IJ A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees.[unboundmedicine.com]
  • Symptoms Fever Chills, malaise Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain) Joint swelling (knees, wrists, ankles) Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps Painful tendons[health.am]
Malaise
  • Symptoms Fever Chills, malaise Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain) Joint swelling (knees, wrists, ankles) Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps Painful tendons[health.am]
  • Patients have fever, chills, and malaise and then develop multiple inflamed tendons and subsequent cutaneous manifestations. The skin lesions classically start as flat erythematous macules, which rapidly develop into hemorrhagic vesiculopustules.[derm101.com]
  • Symptoms that commonly occur with DGI include: fever or chills feeling ill or generally unwell (malaise) pain in the joints swelling of the joints pain in the tendons of the wrists or heels a skin rash with pink or red spots that become filled with pus[healthline.com]
Rigor
  • URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services.[lmcmc.com]
Unsafe Sexual Practices
  • Latex condoms help protect against gonorrhea and other sexually transmitted diseases when the status of a partner is unknown or unsafe sexual practices are indulged in.[health.am]
Tachycardia
  • Patients with gonococcal meningitis exhibit meningeal signs and mental status changes while those with gonococcal endocarditis develop tachycardia and a new murmur.[symptoma.com]
  • The initial ECG showed tachycardia and slight ST-T depressions which were completely absent 1 week later when an ectopic atrial rhythm was present in a part of the recording. The ECG:s thus did not indicate pericarditis.[docksci.com]
Arthritis
  • Gonococcemia (also known as "Arthritis–dermatosis syndrome" [1] and "Disseminated gonococcal infection" [1] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis of one or several[en.wikipedia.org]
  • Laboratory studies were consistent with an acute septic arthritis and the diagnosis of the gonococcal arthritis-dermatitis syndrome was entertained. Read More Disseminated gonorrhea: diagnosis through contact tracing.[pubfacts.com]
  • A case of gonococcemia in pregnancy in which the patient presented with the classic clinical manifestations of gonococcemia--cutaneous lesions, arthritis, and possibly pericarditis--is reported.[ncbi.nlm.nih.gov]
  • Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" [ 1 ] and "Disseminated gonococcal infection" [ 1 ] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis[enacademic.com]
Arthralgia
  • Gonococcemia (also known as "Arthritis–dermatosis syndrome" [1] and "Disseminated gonococcal infection" [1] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis of one or several[en.wikipedia.org]
  • English Wikipedia - The Free Encyclopedia Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" and "Disseminated gonococcal infection") is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia[thesaurus.babylon-software.com]
  • Gonococcemia Gonococcemia (also known as "Arthritis–dermatosis syndrome" [ 1 ] and "Disseminated gonococcal infection" [ 1 ] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis[enacademic.com]
  • The arthralgia encompasses numerous, asymmetrical joints and is typically associated with sterile culture from synovial fluid. Polyarthralgia and tenosynovitis more commonly involve the joints of the hands and feet such as wrists and ankles.[symptoma.com]
Migratory Polyarthritis
  • polyarthritis, tenosynovitis, and dermatitis ( pustular skin lesions). [3] See also [ edit ] Primary gonococcal dermatitis List of cutaneous conditions References [ edit ] a b Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007).[en.wikipedia.org]
  • […] also known as "Disseminated gonococcal infection" [1] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis of one or several joints. [2] It's characterized by a triad of symptoms: migratory[howlingpixel.com]
  • Patients with DGI may present with symptoms of rash, fever, arthralgias, migratory polyarthritis, septic arthritis, tendonitis, tenosynovitis, endocarditis, or meningitis.[emedicine.medscape.com]
Joint Effusion
  • There were no skin lesions, nodules or joint effusions. The patient had a tunnelled central venous device in her right internal jugular vein and the insertion site had no erythema or discharge.[cmaj.ca]
  • Suspected disseminated gonococcal infection When DGI is suspected, blood and joint effusions should be sent for Gram stain and culture, although negative Gram stain results and sterile cultures do not rule out disseminated disease.[intranet.tdmu.edu.ua]
Leg Pain
  • South Med J 1975 May;68(5):636-8 A 19-year-old man was admitted to the hospital with acute onset of fever, sore thoart, and leg pain.[pubfacts.com]
Cutaneous Manifestation
  • @article{19e6375e68624cd3922016de4ef3ba9d, title "Cutaneous Manifestations of Gonococcemia: A Review of 14 Cases", author "Hanna Abu-Nassar and Norwood Hill and Fred, {Herbert L.} and Yow, {Ellard M.[uthealth.influuent.utsystem.edu]
  • A case of a Moraxella osloensis bacteremia mimicking a case of gonococcemia, complete with cutaneous manifestations, is presented. The importance of confirming all positive smears with inhibitory and noninhibitory culture media is stressed.[ncbi.nlm.nih.gov]
  • The subject of cutaneous manifestations of gonococcemia is reviewed. Full Text Download PDF Full Text Cite This Citation ACKERMAN AB, MILLER RC, SHAPIRO L. Gonococcemia and Its Cutaneous Manifestations.[jamanetwork.com]
  • Cutaneous manifestations are described below. The arthralgia encompasses numerous, asymmetrical joints and is typically associated with sterile culture from synovial fluid.[symptoma.com]
  • Goldman Cutis 1978 A case of a Moraxella osloensis bacteremia mimicking a case of gonococcemia, complete with cutaneous manifestations, is presented… (More) Albert Bernard Ackerman The New England journal of medicine 1970 CHARACTERISTIC cutaneous lesions[semanticscholar.org]
Papule
  • Erythema toxicum is characterized by blotchy red spots on the skin with overlying white or yellow papules or pustules. These lesions may be few or numerous.[howlingpixel.com]
  • Pustules and papules against a background of erythema and telangiectasia Picture BACK TO TOP[tools.anwresidency.com]
  • Arch Dermatol 1981 Jan;117(1):26-8 We describe here nine women who had similar distinctive clinical features that consisted of painful red-to-purple macules, papules, and plaques on the digits, predominantly on the toes.[pubfacts.com]
Purpura
  • Solar purpura Solar purpura (also known as "Actinic purpura," and "Senile purpura") is a skin condition characterized by large, sharply outlined, 1- to 5-cm, dark purplish-red ecchymoses appearing on the dorsa of the forearms and less often the hands.The[howlingpixel.com]
  • Date Added: 2018-01-06 Disseminated Gonococcal Infection Gonococcemia Gonorrhea Herpes Simplex Herpetic Whitlow Leukocytoclastic Vasculitis Meningococcemia Purpura Fulminans Syphilis Toxic Shock Syndrome comments powered by This is an experimental application[gulfdoctor.net]
  • A- Acute interstitial nephritis B- Henoch-Schonlein purpura C- Good pasture’s syndrome ephritis D- Alport’s syndrome E- Benign recurrent hematuria D 15. A 65-year-old white woman presents with a two-month history of fatigue and weight gain.[coursehero.com]
  • […] follows, extensive ecchymoses and necrotic ulceration "Purpura fulminas" • DIC disseminated intravascular coagulation • High mortality • Streptococcal pharyngitis, occ wounds or burns • Eruption develops 24 to 48h after onset of pharyngitis with exudate[quizlet.com]
Exanthema
  • The typical clinical picture consisted of fever, joint affection combined with a vesiculopapular, frequently hemorrhagic exanthema and genital gonococcal infection with usually slight or no symptoms and a good general condition throughout.[tandfonline.com]
  • Exanthem An exanthem or exanthema (from Greek ἐξάνθημα exánthēma, "a breaking out") is a widespread rash usually occurring in children. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease.[howlingpixel.com]
  • The others arrived with the diagnosis of cystopyelitis or rheumatic infection, erythema nodosum, rheumatic fever or lues, "exanthema and arthritis" and, in 3 cases, "fever of unknown origin".[docksci.com]
Pustular Rash
  • An erythematous skin rash or acute pustular rash (40%), recent signs of genital infection (75% of cases in man, less than 50% in women) suggest the diagnosis.[pubfacts.com]
  • A vesico-pustular rash and arthralgia. Clin Exp Dermatol. Jan 2001;26(1):113-4. [View Abstract] Belding ME, Carbone J. Gonococcemia associated with adult respiratory distress syndrome. Rev Infect Dis. Nov-Dec 1991;13(6):1105-7.[misc.medscape.com]
Vaginal Discharge
  • However, you may experience: thick discharge from the penis increased vaginal discharge painful urination spotting between menstrual periods swollen testicles painful bowel movements anal itching When gonorrhea infections aren’t treated, the bacteria[healthline.com]
  • She denied dysuria, vaginal discharge, sore throat, insect or animal bites, inappropriate exposure to body fluids, or history of STDs. She did have recent new tattoos.[shmabstracts.com]
  • No vaginal discharge appeared, and no signs of cystitis. Upon admission her general condition was unaffected. The temperature was 38.7 , the blood pressure 200/110 mmHg.[docksci.com]
  • Symptoms in females include painful urination, vaginal discharge, and vaginal bleeding between periods. If untreated, the infection may lead to pelvic inflammatory disease.[fpnotebook.com]

Workup

As a frequent cause of medical visits in young sexually active adults [10], gonococcemia should be suspected when an individual in this population presents with at least a rash and tenosynovitis [3]. Moreover, it is paramount to diagnose and treat these patients promptly to prevent complications. The workup is composed of the patient's history and risk factors, physical exam, and the appropriate studies.

Laboratory tests

The microbial diagnostic tools include culture and/or nucleic acid amplification tests (NAATs) of samples obtained from the genital tract, extragenital sites, blood, synovial fluid, skin, and cerebrospinal fluid if applicable [5] [11]. Also, blood and joint fluid specimens should be assessed with a Gram stain.

With regards to the results, negative findings do not rule out the diagnosis of gonococcemia. For example, joint aspirates, skin lesions, and blood cultures are commonly sterile in these patients [3] [6] while asymptomatic sites may demonstrate an infection [3].

Further important studies include a complete blood count (CBC), which may reveal mild leukocytosis, and erythrocyte sedimentation rate (ESR), which can be slightly elevated.

Other

The United States Preventive Services Task Force (USPSTF) recommends screening for the presence of concurrent STDs such as chlamydia, syphilis, and HIV [12]. Additionally, women of reproductive age with STDs should have a pregnancy test.

Procedures

Patients with affected joints should undergo fluid aspiration and those suspected to have meningitis warrant a lumbar puncture.

Pulmonary Infiltrate
  • The patient had severe hypoxemia and diffuse pulmonary infiltrates. The diagnosis of disseminated gonorrhea was confirmed by the isolation of Neisseria gonorrhoeae from one of several typical appearing skin lesions.[ncbi.nlm.nih.gov]
Neisseria Gonorrhoeae
  • Neisseria gonorrhoeae, also known as Gonococci (plural), or Gonococcus (singular) ... · impetigo · candidiasis · gonococcemia · dermatophyte · coccidioidomycosis ...[bio-medicine.org]
  • The diagnosis of disseminated gonorrhea was confirmed by the isolation of Neisseria gonorrhoeae from one of several typical appearing skin lesions.[ncbi.nlm.nih.gov]
  • Blood cultures grewbeta lactamase negative Neisseria gonorrhoeae andthe Neisseria gonorrhoeae/Chlamydia trachomatisprobe was positive for both N. gonorrhoeae and C.trachomatis.[philpapers.org]
  • Gonococcal septicemia in men has generally been associated with recent or concomitant acute gonorrhea, 1,2 whereas gonococcemia is women frequently develops in asymptomatic carriers of Neisseria gonorrhoeae .[jamanetwork.com]

Treatment

  • Additional treatment information Antimicrobial resistance in N. gonorrhoeae is common. Treatment failures should prompt evaluation for both patient compliance and for antimicrobial resistance.[derm101.com]
  • Recommendations regarding recognition of gonococcemia, criteria for diagnosis, and treatment are presented.[ncbi.nlm.nih.gov]
  • Symptoms typically improve within one to two days of starting treatment. Your long-term outlook may not be as good if you don’t seek treatment for your symptoms or if you don’t follow your doctor’s recommendations for treatment.[healthline.com]
  • For gonococcemia, treatment is usually first given through an IV rather than by mouth. Since chlamydia frequently occurs along with gonorrhea, treatment for chlamydia is often given at the same time.[lmcmc.com]

Prognosis

  • (See Pathophysiology, Prognosis, and Presentation.) Did this answer your question? Yes No Additional feedback? (Optional) Thank you for your feedback![medscape.com]
  • Expectations (prognosis) The outcome is expected to be good when compliance with therapy is maintained.[health.am]
  • Support Groups Expectations (prognosis) The outcome is expected to be good when compliance with therapy is maintained.[amamed.com]
  • Outlook (Prognosis) Symptoms usually improve within 1 to 2 days of starting treatment. Full recovery can be expected. Possible Complications Untreated, this condition may lead to persistent joint pain.[baptistjax.com]

Etiology

  • STDs caused by bacteria can be treated with antibiotics, although the susceptibility pattern of many etiologic microbes has changed over the past few decades. Syphilis remains best managed with single-dose benzathine penicillin G.[unboundmedicine.com]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Etiology Neisseria gonorrhea usually causes a urethritis or cervicitis by adhering to the mucosal epithelium via pili or other adhesion factors.[dermatologyadvisor.com]

Epidemiology

  • Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder.[books.google.ro]
  • References Epidemiology Frequency United States The incidence of DGI naturally parallels the incidence of gonococcal infection. In the United States, the number of gonococcal infections peaked in the 1970s, the era of the sexual revolution.[misc.medscape.com]
  • Michael Whelan at the Public Health Ontario Laboratories for their assistance in compiling epidemiologic surveillance data of gonorrhea.[cmaj.ca]
  • Annual epidemiological report: reporting on 2011 surveillance data and 2012 epidemic intelligence data. 2013. [9th August 2014] [ ]. Direcção Geral de Saúde. Doenças de Declaração obrigatória: 2009-2012. Volume II. 2014. [12th September 2014] [ ].[revista.spdv.com.pt]
Sex distribution
Age distribution

Pathophysiology

  • Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder.[books.google.ro]
  • Pathophysiology Both host and bacterial factors probably contribute to the pathogenesis.[dermatologyadvisor.com]

Prevention

  • Moreover, it is paramount to diagnose and treat these patients promptly to prevent complications. The workup is composed of the patient's history and risk factors, physical exam, and the appropriate studies.[symptoma.com]
  • Abstinence is the only sure prevention. Other prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner is one good means of prevention.[lmcmc.com]

References

Article

  1. Hook EW III, Handsfield HH. Gonococcal infections in the adult. In: Holmes KK, Sparling PF, Stamm WE, et al., eds. Sexually Transmitted Diseases. 4th ed. New York, NY: McGraw-Hill; 2008.
  2. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part I. J Am Acad Dermatol. 1999;41(4):511–532.
  3. Lohani S, Nazir S, Tachamo N, Patel N. Disseminated gonococcal infection: an unusual presentation. J Community Hosp Intern Med Perspect. 2016;6(3):31841.
  4. Ross JD. Systemic gonococcal infection. Genitourin Med. 1996;72(6):404–7.
  5. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. 2005;19(4):853–61.
  6. Mayor MT, Roett MA, Uduhiri KA. Diagnosis and Management of Gonococcal Infections. Am Fam Physician. 2012;86(10):931-938.
  7. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003; 17(2):201-8.
  8. Bunker D, Kerr LD. Acute myopericarditis likely secondary to disseminated gonococcal infection. Case Rep Infect Dis. 2015;2015:385126.
  9. Lee MH, Byun J, Jung M, et al. Disseminated gonococcal infection presenting as bacteremia and liver abscesses in a healthy adult. Infect Chemother. 2015;47(1):60–3.
  10. O'brien JP, Goldenberg DL, Rice PA. Disseminated gonococcal infection: A prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore) 1983;62(6):395–406.
  11. Centers for Disease Control and Prevention (CDC). 2015 STD Treatment Guidelines. http://www.cdc.gov/std/tg2015/gonorrhea.htm. Accessed online December 8, 2016.
  12. Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. Am Fam Physician. 2008;77(6):819-24.

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Last updated: 2019-07-11 22:25