Edit concept Question Editor Create issue ticket

Meningococcemia

Neisseria meningitidis triggers upper respiratory infection, subsequent septicemia and possibly meningitis. Septicemia caused by this pathogen is also referred to as meningococcemia.


Presentation

Meningococcemia may be preceded by an infection of the upper respiratory tract. Septicemia itself manifests in form of chills, fever, headache, nausea, vomiting and generalized skin rash that develop within a very short time [9]. Additionally, petechiae, purpura and ecchymoses may become visible [10]. These dermatological symptoms are usually considered the earliest pathognomonic sign for septicemia. In some cases, areas of skin may become gangrenous. Diarrhea has been observed.

Peracute onset of symptoms resembles Waterhouse Friderichsen syndrome. The latter describes a fulminant form of septicemia and may be triggered by meningococci, pneumococci and other bacterial species. Progression is extremely rapid, high fever is developed and skin rash affects the whole body within hours. Often, severe hypotension is already detected during first examination, fever may subsequently turn into hypothermia and patients are at great risk of septic shock and multi organ failure [11].

Of note, chronic meningococcemia has been described. It is marked by periods of remission and exacerbation that may occur over the course of months. Fever, overall weakness, headache and skin rash come and go.

Patients suffering from meningococcemia may also present meningococcal meningitis. Typical symptoms for meningitis are fever, headache, photophobia, nausea, vomiting and a stiff neck. Due to inflammation of the meninges, movements of the cervical spine may be painful and the corresponding muscles are usually tensed. This symptom complex is also known as meningismus and is not pathognomonic for meningococcal meningitis.

Because N. meningitidis is a facultative pathogen that causes severe meningococcal disease primarily in immunodeficient patients, other symptoms may be present that result from underlying diseases and immunosuppression itself. For instance, infections of the respiratory tract are not necessarily cured when meningococcemia occurs.

Fever
  • Chronic meningococcemia is a rare diagnosis seen in patients with recurrent fever and rash. We describe a case of chronic meningococcemia in a teenage girl who presented with a recurrent painful rash, without fever, over a period of 8 weeks.[ncbi.nlm.nih.gov]
  • Progression is extremely rapid, high fever is developed and skin rash affects the whole body within hours.[symptoma.com]
  • : Marburg virus Ebola Dengue hemorrhagic fever Malaria Kyasanur Forest disease Yellow fever Viral hemorrhagic fever, other Crimean-Congo hemorrhagic fever Best Tests Subscription Required Management Pearls Subscription Required Therapy Subscription Required[visualdx.com]
High Fever
  • Every child with purpuric rash and high fever should be treated as meningococcemia - until proven otherwise. * Rash, pinpoint red spots (petechiae) * High fever * Severe headache * Severe malaise Treatment Immediate treatment of a suspected case of meningococcemia[streetdirectory.com]
  • The girl, a resident of Barangay Bancal in Meycauayan, Bulacan, was taken to the hospital after she showed symptoms of meningococcemia such as high fever, diarrhea and rashes.[philstar.com]
  • The disease is characterized by sudden onset of high fever for 24 hours, stiff neck, delirium; altered mental state; vomiting; cough; sore throat; pinpoint rashes that become wider and appear like bruises starting on the legs and arms; large map-like,[news.abs-cbn.com]
  • Part I Sophia, an 11-month-old baby, developed high fever, malaise, and a rash. Her parents took her to a nearby hospital. In the emergency department, the pediatrician diagnosed septic shock with purpura fulminans.[pediatrics.aappublications.org]
Chills
  • The clinical picture was typically intermittent fever with chills, skin eruptions, maculopapules (often hemorrhagic) and arthritis/arthralgia in a person in good general condition.[ncbi.nlm.nih.gov]
  • Rarely, medical professionals diagnose a chronic form of meningococcemia characterized by recurrent episodes of fever (fever that comes and goes), chills, night sweats , headache , anorexia , and associated with skin rash.[emedicinehealth.com]
  • That includes the body aches, the chills, fever, the lethargy and just kind of feeling down and out." The bacteria is usually contracted through shared respiratory droplets, but can occasionally be transmitted on hard surfaces.[klcc.org]
  • After this initial period, the patient will often complain of continued fever, shaking chills, overwhelming weakness, and even a feeling of impending doom. The organism is multiplying in the bloodstream, unchecked by the immune system.[healthofchildren.com]
  • February 2008 Published: 15 March 2008 Keywords Quinolones Metabolic Acidosis Obstetric Complication Watery Diarrhea Neisseria Meningitidis A 31-year-old woman without history of systemic diseases presented to the emergency department with spiking fever, chills[intjem.biomedcentral.com]
Fatigue
  • The symptoms for meningococcemia are similar to flu that include fever, headache, fatigue and body ache. It is an infection caused by the same type of bacteria that can cause meningitis. BELLY M. OTORDOZ[manilatimes.net]
  • Symptoms and signs are the following for the meningitis type of meningococcemia: Headache Stiff neck Fever Nausea Vomiting Altered mental status Sensitivity to light (photophobia) Symptoms and signs for meningococcemia are fever, fatigue , weakness, nausea[emedicinehealth.com]
  • In contrast, patients with meningococcemia without meningitis may lack the classic headache and neck stiffness, but rather present with more vague complaints such as fatigue, myalgias, and arthralgias.[journals.lww.com]
  • Symptoms of meningococcal disease often resemble those of the flu or other minor febrile illness, making it sometimes difficult to diagnose, and may include high fever, severe headache, stiff neck, rash, nausea, vomiting, fatigue, and confusion.[oregonlive.com]
  • Early symptoms of meningococcal disease tend to resemble those of common viral infections like colds or influenza, including fever, headaches, and fatigue.[wiscontext.org]
Malaise
  • The next morning, because of fever and malaise, he was taken to the emergency department, where he was found to be hypotensive, with cool, cyanotic hands and feet. Neither petechiae nor purpura was present; no meningismus was noted.[nejm.org]
  • . * Rash, pinpoint red spots (petechiae) * High fever * Severe headache * Severe malaise Treatment Immediate treatment of a suspected case of meningococcemia begins with antibiotics that work against the organism.[streetdirectory.com]
  • Part I Sophia, an 11-month-old baby, developed high fever, malaise, and a rash. Her parents took her to a nearby hospital. In the emergency department, the pediatrician diagnosed septic shock with purpura fulminans.[pediatrics.aappublications.org]
  • Conclusion Neisseria meningitidis infection in the first 4 to 8 hours typically occurs with fever, irritability, nausea or vomiting, somnolence, decreased appetite, sore throat, runny nose and malaise, followed in 12 to 15 hours of hemorrhagic rash, neck[omicsonline.org]
Tachypnea
  • Meningococcemia is characterized by the following [3] : Fever Initial rash that may be erythematous or maculopapulars, short lived, followed by petechiae and purpura Vomiting Headache Myalgias that may be quite severe Sore throat Abdominal pain Tachycardia/tachypnea[emedicine.medscape.com]
Vomiting
  • There was a 2- to 3-day history of a runny nose, cough, and vomiting. On the day of admission, A.W. had three seizures and developed a fever and a purpuric rash.[ncbi.nlm.nih.gov]
  • Fever, nausea and vomiting are less specific. Treatment consists of systemic antibiotic therapy and supportive measures.[symptoma.com]
  • However, the following symptoms in a child may occur: Irritability Slow reactions or inactivity Lethargy Poor feeding Vomiting Symptoms and signs for meningococcemia (also termed meningococcal septicemia) are fever, fatigue , weakness, nausea, vomiting[emedicinehealth.com]
  • Very rarely, an individual may develop an illness with signs and symptoms of fever, headache, sometimes with a rash, stiff neck, vomiting, lethargy or change in consciousness.[news.cornell.edu]
  • Figure 1 A 14-year-old boy with a four-year history of systemic lupus erythematosus (controlled by daily treatment with 5 mg of prednisone) reported feeling weak and warm and subsequently began to have abdominal pain and vomiting.[nejm.org]
Nausea
  • Fever, nausea and vomiting are less specific. Treatment consists of systemic antibiotic therapy and supportive measures.[symptoma.com]
  • Symptoms and signs are the following for the meningitis type of meningococcemia: Headache Stiff neck Fever Nausea Vomiting Altered mental status Sensitivity to light (photophobia) Symptoms and signs for meningococcemia are fever, fatigue , weakness, nausea[emedicinehealth.com]
  • Symptoms include fever, headache, rash consisting of small spots, nausea, irritability and anxiety. style "display:block; text-align:center;" data-ad-layout "in-article" data-ad-format "fluid" data-ad-client "ca-pub-2836569479021745" data-ad-slot "1977900730[sunstar.com.ph]
  • Health officials say the person did not test positive for meningitis It is not an airborne disease Alerts have been put out for three bars in Boone It causes an array of symptoms like fever, stiff neck, severe headache, nausea, vomiting and light sensitivity[spectrumlocalnews.com]
  • Meningococcal disease symptoms are fever, headache, stiff neck, nausea, vomiting, photophobia and confusion. Anyone with questions concerning symptoms can contact Student Health Services at 828-262-3100.[theappalachianonline.com]
Diarrhea
  • There has been very rarely described in the literature a syndrome similar to gastroenteritis with diarrhea, vomiting and abdominal pain, [ 10 ] reason for this two-cases-presentation, as both of them had diarrhea and vomiting prior to the presentation[omicsonline.org]
  • Neisseria Meningitidis A 31-year-old woman without history of systemic diseases presented to the emergency department with spiking fever, chills, generalized myalgia, severe epigastralgia, and watery diarrhea for 1 day.[intjem.biomedcentral.com]
  • The girl, a resident of Barangay Bancal in Meycauayan, Bulacan, was taken to the hospital after she showed symptoms of meningococcemia such as high fever, diarrhea and rashes.[philstar.com]
  • […] are the following for the meningitis type of meningococcemia: Headache Stiff neck Fever Nausea Vomiting Altered mental status Sensitivity to light (photophobia) Symptoms and signs for meningococcemia are fever, fatigue , weakness, nausea, vomiting, diarrhea[emedicinehealth.com]
  • Tumors 479 Wilms Tumor 481 Neuroblastoma 482 Retinoblastoma 484 Histiocytic Proliferative Diseases 485 Genitourinary System 486 Enuresis 487 Glomerulonephritis 490 Nephrotic Syndrome 495 Hypertension 518 Gastrointestinal System 523 Chronic Nonspecific Diarrhea[books.google.com]
Food Poisoning
  • Here we report a non-fatal case of fulminant form of meningococcemia beginning as food poisoning complicated with shock I degree due to partially adrenal hemorrhage in Caucasian adult male.[ncbi.nlm.nih.gov]
Tachycardia
  • Five days after such treatment, the baby presented with progressive systemic rash, fever and tachycardia. The patient died from meningococcemia. This case serves as a warning concerning the course of condyloma in infants.[ncbi.nlm.nih.gov]
  • He had severe hypotension and tachycardia despite receiving serotherapy, as well as coagulopathy and acute renal failure. BP: 94/36 mmHg; HR 132 bpm; temperature 40.5 C.[elsevier.es]
  • Fulminant Meningococcemia: - Sudden onset of fever, tachycardia & hypotension are the early symptoms. - Sudden toxemia kills the patient within 6-26 hours. - Evidence of meningitis is uncommon due to rapid course. - Meningococcemia is the main cause of[histopathology-india.net]
  • […] variable intensity) Fulminant meningococcemia: Purpuric eruption, hemorrhages on buccal mucosa and conjunctivae, no signs of meningitis, cyanosis, hypotension, profound shock, high fever, pulmonary insufficiency Meningococcal septicemia: Fever, rash, tachycardia[emedicine.medscape.com]
Refractory Shock
  • Adjunctive and Experimental Therapies Corticosteroid therapy: Replacement doses (25 mg/m3 hydrocortisone 4 times) daily is useful in children with refractory shock associated with impaired adrenal gland response.[ncbi.nlm.nih.gov]
Purpura
  • The dual functional properties of APC are particularly relevant to severe meningococcemia, where acquired PC deficiency is accompanied by multiorgan failure and purpura fulminans.[ncbi.nlm.nih.gov]
Petechiae
  • Meningococcal infection should be considered in patients who have fever along with skin rash or petechiae even when there are no signs of meningitis. In this report, we also review case reports of meningococcemia without meningitis in Japan.[ncbi.nlm.nih.gov]
  • Petechiae are the most common cutaneous sign, seen in one-third to one-half of affected patients. Altered mental status, nuchal rigidity, seizures, and gait disturbance can also occur.[visualdx.com]
  • Neither petechiae nor purpura was present; no meningismus was noted.[nejm.org]
  • Petechiae and purpura may progress and coalesce so that much of the skin is involved. Purpura fulminans is seen with fulminant meningococcemia.[journals.lww.com]
  • Photophobia (96.1% specificity) Purpuric Rash See Morsel on Petechiae and Fever Initially is subtle often with just erythema. Evolves to petechiae and purpura representing microvascular thrombosis and hemorrhage.[pedemmorsels.com]
Papular Rash
  • Meningococcemia commonly presents with a petechial rash and a transient macular or papular rash is sometimes present.[ncbi.nlm.nih.gov]
Arthritis
  • This case showed various neurological complications such as abducens palsy, cerebellitis, and cerebellar infarction, and reactive arthritis.[ncbi.nlm.nih.gov]
  • A39.84 Postmeningococcal arthritis Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.[icd10data.com]
  • Arthritis occurs in approximately 5% of meningococcal infections and may present as a purulent synovitis, sterile polyarthritis,3 monoarthritis, or as a tenosynovitis.[healio.com]
  • Complications of acute meningococcemia include pericarditis / myocarditis, disseminated intravascular coagulation (DIC), meningitis and permanent neurologic sequelae, septic arthritis, osteomyelitis, adrenal hemorrhage (Waterhouse-Friderichsen syndrome[visualdx.com]
Myalgia
  • She had intermittent fever, purpuric papules disseminated on the trunk and limbs, headache, arthralgia and myalgia for 5 weeks. Treatment with ceftriaxone was rapidly successful.[ncbi.nlm.nih.gov]
  • 15 March 2008 Keywords Quinolones Metabolic Acidosis Obstetric Complication Watery Diarrhea Neisseria Meningitidis A 31-year-old woman without history of systemic diseases presented to the emergency department with spiking fever, chills, generalized myalgia[intjem.biomedcentral.com]
  • The clinical picture of acute meningococcemia consists of headache, nausea, vomiting, and severe myalgias that quickly lead to obtundation and a septic-appearing patient. Patients may report a preceding upper respiratory tract infection.[visualdx.com]
  • In contrast, patients with meningococcemia without meningitis may lack the classic headache and neck stiffness, but rather present with more vague complaints such as fatigue, myalgias, and arthralgias.[journals.lww.com]
  • Then, 10 months after the vaccine had been administered, the patient visited the emergency department and was admitted to the ICU with pharyngeal discomfort, left earache associated with myalgia and a fever of 40 C.[elsevier.es]
Arthralgia
  • She had intermittent fever, purpuric papules disseminated on the trunk and limbs, headache, arthralgia and myalgia for 5 weeks. Treatment with ceftriaxone was rapidly successful.[ncbi.nlm.nih.gov]
  • Chronic meningococcemia is characterized by a persistent low fever, rash, and arthralgias, and it is commonly mistaken for gonococcemia.[visualdx.com]
Back Pain
  • The most common symptoms of meningitis can include fever, neck or back pain, headache, neck stiffness, nausea and vomiting, and a rash. Treatment is needed right away. Your child will need to be in a hospital for treatment.[urmc.rochester.edu]
  • In children older than 1 year, symptoms may include: Fever Neck and/or back pain Headache Nausea and vomiting Neck stiffness A purple-red, splotchy rash or skin discoloration may appear as the disease progresses In infants, symptoms are difficult to pinpoint[stanfordchildrens.org]
  • Signs and symptoms of meningococcal disease Meningococcal meningitis Meningococcemia Children 1 year and adults Neck stiffness Headache Nausea and vomiting Neck and/or back pain Fever and chills Increased sensitivity to light Irritability, confusion Infants[dermnetnz.org]
Headache
  • She had intermittent fever, purpuric papules disseminated on the trunk and limbs, headache, arthralgia and myalgia for 5 weeks. Treatment with ceftriaxone was rapidly successful.[ncbi.nlm.nih.gov]
  • Fever, overall weakness, headache and skin rash come and go. Patients suffering from meningococcemia may also present meningococcal meningitis. Typical symptoms for meningitis are fever, headache, photophobia, nausea, vomiting and a stiff neck.[symptoma.com]
  • Very rarely, an individual may develop an illness with signs and symptoms of fever, headache, sometimes with a rash, stiff neck, vomiting, lethargy or change in consciousness.[news.cornell.edu]
  • Muscle and joint pain with headache as well as a skin rash may also come and go. This form of the disorder may also include an enlarged spleen.[rarediseases.org]

Workup

Anamnesis and clinical examination may prompt a suspicion of meningococcemia, especially if patients also present with signs of meningitis. However, they do not allow for a definitive diagnosis. The latter requires obtaining samples of blood and cerebrospinal fluid and establishing bacterial cultures. By no means, initiation of treatment should be delayed until the results of laboratory analyses are available. This may take several days. Rapid latex agglutination tests and other biochemical methods may serve to obtain preliminary results.

Aiming at immediate identification of the causative pathogen, skin biopsies have been used for microscopic examination. N. meningitidis are diplococci and detection of microorganisms organized in such a way strongly supports diagnosis of meningococcal disease. However, false negative results are common [12].

Skin biopsies may nevertheless be they key to an improved diagnosis of meningococcal disease: Newer research focuses on developing molecular biological methods to provide information about the etiologic agent in much shorter periods of time. Polymerase chain reactions may be conducted with nucleic acids isolated from such tissue samples and so far, results are highly promising [13]. The challenge is to design primers that allow amplification of gene sequences carried by as many serotypes as possible. Otherwise, specific tests would have to be carried out for each serotype that differs [14]. Also, molecular biological methods may not be universally available.

Treatment

Meningococcemia is generally treated with beta-lactam antibiotics like penicillin. While penicillin is usually not effective against gram-negative bacteria, it does kill gram-negative cocci such as Neisseria. This antibiotic drug is not only effective, but also rather inexpensive and easily available even in underdeveloped countries. In case of penicillin allergy, cephalosporins may be applied [15].

In case of survival of severe meningococcemia, long-term sequelae due to persistent vascular problems may require additional medical attention [11]. Ischemia may be irreversible and cause gangrenous alterations. In such cases, an amputation may be indicated. Orthopedic sequelae are not uncommon either and should be treated accordingly.

Prognosis

Prognosis is good if an adequate treatment is provided in a timely manner. Any delay regarding the initiation of therapy considerably worsens the outcome. Septic shock is associated with a doubtful prognosis and mortality rates in shock patients amount up to 50% [8]. Shock may lead to disseminated intravascular coagulation and multi organ failure, which are very unfavorable prognostic parameters that are associated with mortality rates of up to 90%.

Etiology

Causative agent of meningococcemia is N. meningitidis, a gram-negative, facultatively anaerobic diplococci that replicates intracellularly [2]. There are different serogroups of N. meningitidis, the most important ones being A, B, C, W135 and Y. These serotypes account for more than 90% of all infections.

N. meningitidis demand special media for bacterial culture, e.g., blood agar plates. They are also rather slow growing, which is why confirmation of infection with Neisseria and identification of the serotype takes several days. Nevertheless, bacterial culture is still considered the gold standard for diagnosis of meningococcemia. Although latex agglutination tests may also be carried out, they are less specific. Samples of blood, cerebrospinal fluid and even scrapings of skin lesions are suitable for such testing.

N. meningitidis may colonize mucous membranes of the upper respiratory tract without triggering any symptoms. While such carriers, mainly immunocompetent individuals, may never develop meningococcemia, they are of great epidemiological importance since they usually don't receive any treatment but pass pathogens to other people. They may remain infectious for months. Close contact with carriers or patients bears a high risk of infection since N. meningitidis is spread by means of airborne droplets. Although few cases are known where health care givers contracted the disease from patients they were working with, this possibility should not be underestimated and adequate preventive measures are highly recommended. This also applies to laboratory personnel.

Epidemiology

Infections with N. meningitidis may cause meningococcemia, meningitis or both of these conditions. While some sources state that less than 10% of affected individuals present with sole meningococcemia, others have published this share of patients to amount to 50%. Fulminant meningococcemia, also termed Waterhouse Friderichsen syndrome, is not a rare occurrence.

N. meningitidis may cause epidemics as well as sporadic disease. There seems to be a relation between the likelihood for epidemics and the respective serotype of the bacterium. In fact, most epidemics are caused by serotype A which is distributed throughout Africa and Asia. African countries located between 20° of northern latitude and 10° of southern latitude, approximately, have been designated the "African meningitis belt" due to particularly high incidence rates of meningitis. Risks are particularly high for children and meningococcal disease is associated with a high mortality in pediatric patients [3].

N. meningitidis serotype B is mainly found in Europe and America, while serotype C is distributed worldwide. Of note, travelers may contract the disease in foreign countries, turn home without having developed any symptoms and infect their fellows [4] [5].

Sex distribution
Age distribution

Pathophysiology

Septicemia due to N. meningitidis dissemination is primarily associated with endothelial damage, consecutively increased vascular permeability and activation of the coagulation cascade.

Endothelial lesions are primarily mediated by endotoxins, i.e., by lipopolysaccharides that form the cell membrane of gram-negative bacteria such as Neisseria [6]. Meningococcemia also induces an intravascular immune response, activation of immune cells and release of pro-inflammatory cytokines as well as reactive oxygen species [7]. These further contribute to vascular damage and may additionally mediate vasodilation.

Vascular permeability rises due to injury of the vessel's inner layer. The subsequent shift of fluids from intravascular to extravascular compartments results in hypotension and this condition is further aggravated by generalized vasodilation.

On the other hand, endothelial damage triggers adhesion and aggregation of thrombocytes and deposition of fibrin. The latter requires a plethora of coagulation factors to interact. Because of excess consumption of thrombocytes and coagulation factors due to generalized activation of coagulation, patients finally develop a disseminated intravascular coagulopathy.

The aforementioned pathophysiological events may lead to septic shock that manifests in form of fever, reduced cardiac output and diminished myocardial contractility, severe hypotension due to vasodilation and increased vascular permeability, disseminated intravascular coagulation and ultimately multi organ failure and death.

Of note, meningococcemia also allows bacteria to reach the meninges, establish an intracranial infection, meningitis and an increase of intracranial pressure. And while meningococcal meningitis is not the topic of this article, it is a direct consequence of meningococcemia and has major clinical relevance.

Prevention

Vaccines are available that protect from meningococcal disease due to infection with distinct serotypes.

As has been mentioned above, most cases are caused by serotypes A, B, C, W135 and Y. Quadrivalent vaccines able to confer protection against serogroups A, C, W135 and Y are available as well as formulations that include certain serotypes of N. meningitidis and other pathogens [16]. There are approved products for infants, children, adolescents, adults and the elderly.

Recommendations regarding general vaccination differ with geographical regions and predominating serotypes. In several countries, it is recommended to firstly vaccinate children aged 12 years and to maintain protection during adulthood. Earlier and later vaccination should be considered for patients with higher risks of contracting the causative pathogen and developing meningococcal disease. Risk groups are:

Temporal restrictions may not allow for an effective vaccination of first aiders and emergency staff who assist in epidemic regions. Similarly, non-vaccinated individuals pertaining to any of the aforementioned risk groups may suddenly find themselves in an epidemic area without an opportunity to protect themselves by vaccination. Family members of patients suffering from meningococcemia are also at risk. In these cases, antibiotic prophylaxis is recommended. Cephalosporins, fluoroquinolones and other compounds may be used to this end.

Summary

Neisseria meningitidis (N. meningitidis) is a gram-negative diplococcus that replicates intracellularly. It is often considered facultatively pathogenic since colonization of the upper respiratory tract does not necessarily induce any disease. N. meningitidis is contracted via droplet infection and people who carry these bacteria in their nasopharynx may easily spread it.

Infection may lead to upper respiratory infection and subsequent septicemia, whereby the latter is called meningococcemia in this particular case. During septicemia, N. meningitidis disseminates by means of the vascular system, may reach the meninges and provoke meningococcal meningitis. However, meningitis is not an exclusion criterion for meningococcemia or vice versa [1]. Patients may present with either of the two conditions or a combination of both. Data regarding the share of patients pertaining to any of these three subgroups varies largely.

Therapy strongly depends on the presence of either pathogenic feature and has to be initiated as soon as possible since both meningococcemia and meningitis are associated with high rates of mortality. In detail, meningococcemia may lead to disseminated intravascular coagulopathy, severe hypotension and septic shock within hours after symptom onset. In this context, generalized skin rash may be the earliest and thus most important sign of septicemia. Fever, nausea and vomiting are less specific. Treatment consists of systemic antibiotic therapy and supportive measures.

Patient Information

Meningococcemia refers to systemic dissemination of certain bacteria, namely those pertaining to the species of Neisseria meningitidis, by means of the vascular system.

Causes

Neisseria meningitidis is a bacterium that lives in nose and throat of possibly asymptomatic carries. It is passed to other individuals by droplet infection, i.e., close contact with a carrier or a person suffering from meningococcal disease increases the risk of contracting the pathogen.

Patients with a weakened immune system are particularly at risk to develop the aforementioned disease. Here, bacteria spread throughout the body and may reach the meninges. Bacterial spread is referred to as meningococcemia; infection of the meninges results in meningococcal meningitis.

Symptoms

Acute onset of fever, headache, nausea, vomiting and skin rash are characteristic for meningococcemia. Dermatological symptoms may manifest first on arms and legs and subsequently spread over the whole body. In severe forms of meningococcemia, this may occur within hours.

Presence of bacteria in the blood stream may trigger a potentially life-threatening cascade of events leading to septic shock. This condition is marked by increased vascular permeability, generalized coagulation and consecutive bleeding tendency, severe hypotension and multi organ failure. In order to avoid these pathophysiological events, therapy should be initiated as soon as possible.

Diagnosis

Medical history and clinical examination only allow for a tentative diagnosis. In order to confirm meningococcemia, the causative agent has to be isolated from blood samples or other affected tissues and needs to be grown in bacterial cultures. This procedure takes several days and will be done, but treatment needs to be started much earlier.

Treatment

Treatment consists in antimicrobial therapy and supportive measures. Several antibiotics are effective against Neisseria meningitidis and although penicillin is most frequently used, there are alternatives for patients presenting with penicillin allergy.

References

Article

  1. Horino T, Kato T, Sato F, et al. Meningococcemia without meningitis in Japan. Intern Med. 2008; 47(17):1543-1547.
  2. Livorsi DJ, Stenehjem E, Stephens DS. Virulence factors of gram-negative bacteria in sepsis with a focus on Neisseria meningitidis. Contrib Microbiol. 2011; 17:31-47.
  3. Pollard AJ, Nadel S, Ninis N, Faust SN, Levin M. Emergency management of meningococcal disease: eight years on. Arch Dis Child. 2007; 92(4):283-286.
  4. Wilder-Smith A. W135 meningococcal carriage in association with the Hajj pilgrimage 2001: the Singapore experience. Int J Antimicrob Agents. 2003; 21(2):112-115.
  5. Wilder-Smith A, Barkham TM, Earnest A, Paton NI. Acquisition of W135 meningococcal carriage in Hajj pilgrims and transmission to household contacts: prospective study. Bmj. 2002; 325(7360):365-366.
  6. Brandtzaeg P, van Deuren M. Classification and pathogenesis of meningococcal infections. Methods Mol Biol. 2012; 799:21-35.
  7. Zughaier SM. Neisseria meningitidis capsular polysaccharides induce inflammatory responses via TLR2 and TLR4-MD-2. J Leukoc Biol. 2011; 89(3):469-480.
  8. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet. 2007; 369(9580):2196-2210.
  9. El Bashir H, Laundy M, Booy R. Diagnosis and treatment of bacterial meningitis. Arch Dis Child. 2003; 88(7):615-620.
  10. Feldman HA. Meningococcal infections. Adv Intern Med. 1972; 18:117-140.
  11. Buysse CM, Oranje AP, Zuidema E, et al. Long-term skin scarring and orthopaedic sequelae in survivors of meningococcal septic shock. Arch Dis Child. 2009; 94(5):381-386.
  12. Arend SM, Lavrijsen AP, Kuijken I, van der Plas RN, Kuijper EJ. Prospective controlled study of the diagnostic value of skin biopsy in patients with presumed meningococcal disease. Eur J Clin Microbiol Infect Dis. 2006; 25(10):643-649.
  13. Parmentier L, Garzoni C, Antille C, Kaiser L, Ninet B, Borradori L. Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia. Arch Dermatol. 2008; 144(6):770-773.
  14. Dolan Thomas J, Hatcher CP, Satterfield DA, et al. sodC-based real-time PCR for detection of Neisseria meningitidis. PLoS One. 2011; 6(5):e19361.
  15. Tuncer AM, Gur I, Ertem U, et al. Once daily ceftriaxone for meningococcemia and meningococcal meningitis. Pediatr Infect Dis J. 1988; 7(10):711-713.
  16. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013; 62(RR-2):1-28.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:54