Dermatologic Manifestations of Meningococcemia Follow-up

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

Deterrence/Prevention

  • Vaccines have been developed that consist of purified capsular polysaccharide.
    • The currently available quadrivalent vaccine contains polysaccharide from serogroups A, C, Y, and W-135. This vaccine is recommended for military personnel and patients younger than 2 years with terminal complement deficiencies or anatomic or functional asplenia. Since the start of vaccination against serogroup C, the prevalence of this disease has decreased.
    • The development of an effective serogroup B vaccine is ongoing. A vaccine that combines meningococcal serogroups B and C is under development.[15]
    • Routine vaccination of civilians with the quadrivalent meningococcal vaccine is not recommended because of its relative ineffectiveness in children younger than 2 years and its relatively short duration of action (approximately 3 y).
  • Antimicrobial chemoprophylaxis is recommended for close contacts of patients with meningococcal disease and is the primary means of prevention in the United States.
    • Close contacts include household members, day care center classmates, and anyone exposed to the patient's respiratory secretions.
    • Institute antimicrobial chemoprophylaxis as soon as possible because the rate of secondary disease is highest in the first few days after the onset of disease in the index case.
    • Current adult recommendations include rifampin at 600 mg orally twice daily for 2 days.
    • In addition to rifampin, other antimicrobial agents are effective in reducing nasopharyngeal colonization with N meningitidis.
      • Ciprofloxacin and ofloxacin are effective single-dose oral substitutes.
      • Ceftriaxone is available for parenteral single-dose use in children and adults.
      • These medications achieve adequate concentrations in upper respiratory tract secretions and are reasonable alternatives to the multidose rifampin regimen for chemoprophylaxis.
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Complications

  • Complications of meningococcemia may occur at the time of acute disease or during the recovery phase.
  • Meningococcal arthritis occurs with acute bacteremia in up to 10% of adult cases.
  • Up to 5% of patients develop a nonpurulent pericarditis with substernal chest pain and dyspnea approximately 1 week after the onset of illness. Involvement of the pericardium in meningococcal disease is a well-recognized but rare complication. It has been described with N meningitidis serotypes C, B, W135, and Y.[16]
  • Neurologic complications (including peripheral neuropathy) have also been documented.
  • Long-term complications in patients who survive fulminant meningococcemia are related to permanent musculoskeletal sequelae.
  • Amputation may be required for extensive tissue necrosis of the limbs.
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Prognosis

  • Several investigators have identified unfavorable prognostic features in patients with meningococcemia using clinical and laboratory parameters at the time of hospitalization.
  • A mortality rate of 40-80% is associated with the acute onset of petechiae less than 12 hours before admission, shock, coma, high fever, low peripheral leukocyte count, thrombocytopenia, high serum antigen titer, absence of meningitis, metabolic acidosis, and disseminated intravascular coagulation (DIC).
  • Cases of fulminant meningococcemia can also be associated with the complication of massive adrenal hemorrhage (Waterhouse-Friderichsen syndrome). In these cases, the mortality rate is close to 100%.
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Patient Education

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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.

References

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