Meningococcemia Clinical Presentation

  • Author: Mahmud H Javid, MBBS; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Oct 26, 2011
 

History

Persons with meningococcal disease may present with a nonspecific prodrome of cough, headache, and sore throat. This is followed by rapid onset of fever with chills, arthralgias, and myalgias. The potential rapidity of progression cannot be stressed enough.

  • In fulminant meningococcemia, collapse occurs within a few hours, with rapid enlargement of petechiae and purpuric lesions. See an example shown below. Petechial lesions on the palm. Courtesy of ProfessPetechial lesions on the palm. Courtesy of Professor Chien Liu.
  • Meningitis that accompanies meningococcemia may result in headache, neck stiffness, lethargy, and drowsiness.
  • Decreased mentation and coma may be present.
  • Young children may present with sudden onset of fever and lethargy. They may also have vomiting and convulsions.
  • In chronic meningococcemia (rare), painful skin lesions are present on the extremities (see the following images), similar to those seen in gonococcemia, with migratory polyarthritis and tenosynovitis. Antibiotic treatment results in a prompt response. Petechial rash on lower extremities. Courtesy of PPetechial rash on lower extremities. Courtesy of Professor Chien Liu. Petechial lesions on the palm. Courtesy of ProfessPetechial lesions on the palm. Courtesy of Professor Chien Liu.
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Physical

Patients with meningococcal disease appear severely ill.

  • Tachycardia and mild hypotension are present.
  • Fever is moderate. High fever is present in fulminant meningococcemia.
  • A petechial rash develops in 50-80% of patients and involves the axillae, flanks, wrists, and ankles as shown in the images below. Petechiae are often located in the center of lighter-colored macules. Lesions commonly begin on the trunk and legs in areas where pressure is applied. They are discrete lesions 1-2 mm in diameter. Confluence of lesions results in hemorrhagic patches, often with central necrosis. Dorsum of the hand showing a petechial rash. CourtDorsum of the hand showing a petechial rash. Courtesy of Professor Chien Liu. Petechial rash on lower extremities. Courtesy of PPetechial rash on lower extremities. Courtesy of Professor Chien Liu.
  • In some cases, a transient maculopapular rash develops, usually lasting for less than 48 hours.[12]
  • Congestive heart failure, gallops, and pulmonary edema may be present. Other evidence of end-organ damage may also rapidly appear.
  • Patients with fulminant meningococcemia rapidly deteriorate clinically, with hypotension and respiratory failure.
  • Pericarditis can occur during the acute disease or in the recovery period and is associated with serogroup C disease.
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Causes

Meningococci (0.6 µm X 0.8 µm) are gram-negative single cocci or diplococci (see the image below) with flattened adjacent sides. Older cultures can vary considerably in size and shape. Serotyping is based on the polysaccharide capsule. The organisms grow at 35-37°C in a moist oxygen-reduced atmosphere containing 5-19% carbon dioxide on media that contains blood.

Gram-negative intracellular diplococci. Courtesy PGram-negative intracellular diplococci. Courtesy Professor Chien Liu.
  • Seroagglutination is used to segregate meningococci into 13 serogroups: A, B, C, D, X, Y, Z, E, W-135, H, I, K, and L. Ninety-eight percent of infections are caused by encapsulated serogroups A, B, C, Y, and W-135.
  • Individuals with complement component deficiencies are at an increased risk for meningococcal infections.
  • Recurrent meningococcemia has also been reported in patients with immunoglobulin G2 subclass deficiency.
  • Splenectomy and host genetic polymorphisms are also risk factors.
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Contributor Information and Disclosures
Author

Mahmud H Javid, MBBS  Consultant, Infectious Diseases, Shifa International Hospital, Islamabad, Pakistan

Mahmud H Javid, MBBS is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS  Associate Professor of Clinical Medicine, The School of Medicine at Stony Brook University Medical Center; Adjunct Clinical Associate Professor, Department of Medicine, New York College of Osteopathic Medicine of New York Institute of Technology; Attending Physician, Department of Medicine, Division of Infectious Diseases, Director of HIV Prevention Services, Administrative HIV Designee, Nassau University Medical Center

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary D Nettleman, MD, MS, MACP  Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Dorsum of the hand showing a petechial rash. Courtesy of Professor Chien Liu.
Petechial lesions on the palm. Courtesy of Professor Chien Liu.
Petechial rash on lower extremities. Courtesy of Professor Chien Liu.
Conjunctival petechiae. Courtesy of Professor Chien Liu.
Gram-negative intracellular diplococci. Courtesy Professor Chien Liu.
 
 
 
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