Dermatologic Manifestations of Meningococcemia Clinical Presentation

  • Author: Elizabeth L Tanzi, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 16, 2011
 

History

  • Meningococcemia follows an upper respiratory tract infection and is associated with headache, nausea, vomiting, myalgias, and arthralgias.
  • Not all patients appear toxic.
  • The initial presentation may be difficult to distinguish from a viral syndrome.
  • While a slower clinical presentation can occur in persons with a milder form of disease, fever may increase dramatically with rapid clinical deterioration.
  • In fulminant meningococcemia, a hemorrhagic eruption, hypotension, and cardiac depression may be apparent within hours of the initial presentation.
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Physical

  • Cutaneous manifestations of meningococcemia are common and can be the presenting sign of disease.
  • Petechiae are the most common sign, occurring in 50-60% of patients with meningococcemia; however, urticarial and maculopapular lesions also may occur initially. Petechiae are most often located on the extremities and trunk but may progress to involve any part of the body. Petechiae may appear in groups under areas of pressure.
  • With progression of meningococcemia, pustules, bullae, and hemorrhagic lesions with central necrosis can develop. Stellate purpura with a central gunmetal-gray hue is characteristic and should be considered highly suggestive of meningococcemia.
  • Large maplike purpuric and necrotic areas related to the development of DIC are characteristic of fulminant meningococcemia.
  • Noncutaneous physical findings are as follows:
    • Altered mental status
    • Neck stiffness
    • Irritability
    • Seizures
    • Nerve palsies
    • Gait disturbance
    • Nausea
    • Vomiting
    • Unstable vital signs
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Causes

  • Most patients with meningococcal disease are previously healthy individuals; however, patients with certain medical conditions are at increased risk for developing meningococcal infection.
  • Meningococcemia is particularly common among individuals with deficiencies of terminal complement components C5-C9 or properdin.
    • These late complement components are required for bacteriolysis of meningococci.
    • An estimated 50-60% of individuals with late complement component deficiencies develop at least one episode of meningococcal disease.
    • Many of these patients experience multiple episodes of infection.
  • Acquired complement deficiencies that occur in association with systemic lupus erythematosus, multiple myeloma, severe liver disease, enteropathies, and the nephrotic syndrome also predispose to meningococcal infection.
  • An association has been described between increased risk of mortality in children with meningococcal disease and polymorphisms in the interleukin 1 cluster.
  • Other risk factors include immunoglobulin deficiency, asplenia, and HIV infection.
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Contributor Information and Disclosures
Author

Elizabeth L Tanzi, MD  Co-Director, Laser Surgery, Washington Institute of Dermatologic Laser Surgery; Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine

Elizabeth L Tanzi, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Nanette Silverberg  MD, Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Director of Pediatric Dermatology, Department of Dermatology, St Luke's Roosevelt Hospital Center, Maimonides Medical Center and Beth Israel Medical Center

Nanette Silverberg is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, American Association of University Women, American Medical Association, American Medical Women's Association, Dermatology Foundation, International Society of Pediatric Dermatology, Phi Beta Kappa, Sigma Xi, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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