Meningococcemia Differential Diagnoses

Updated: Aug 05, 2022
  • Author: Mahmud H Javid, MBBS; Chief Editor: John L Brusch, MD, FACP  more...
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Diagnostic Considerations

The differential diagnosis of acute meningococcemia encompasses multiple entities, including other infectious processes. Although only 2-11% of children with petechiae and fever have invasive meningococcal disease, antibiotic therapy should be started in children and most adults without awaiting confirmatory evidence. Distinguishing meningococcal disease from other causes in these cases is difficult, and the fatality rate is high. Other causes may include the following:

  • Bacterial infections - Pneumococcal septicemia, group A streptococcal septicemia, other gram-positive or gram-negative sepsis, and syphilis
  • Viral infections - Epstein-Barr virus infection, enterovirus infection, measles, rubella, herpes simplex virus infection, cytomegalovirus infection, hemorrhagic viral fevers (eg, dengue)
  • Other infections - Mycoplasma infection (usually maculopapular), Rocky Mountain spotted fever, epidemic typhus, ehrlichiosis, leptospirosis, and Candida infection
  • Platelet disorders - Immune thrombocytopenia, leukemia, other causes of bone marrow failure, Bernard-Soulier disease, and Glanzmann disease
  • Clotting disorders - Hemophilia, von Willebrand disease, vitamin K deficiency, and congenital or acquired protein C or S deficiency
  • Autoantibody-mediated causes - After varicella, rubella, group A hemolytic, Streptococcus, coumarin drugs, cholestasis, renal dialysis, nephrotic syndrome, and bone marrow transplantation
  • Vasculitis - Henoch-Schönlein purpura, polyarteritis, antiphospholipid syndrome, other vasculitides, and Kawasaki disease,
  • Trauma - Injury and violent coughing or emesis
  • Connective tissue disease - Osteogenesis imperfecta, Marfan syndrome, and vitamin C deficiency
  • Miscellaneous - Cushing syndrome, hemolytic uremic syndrome, drug ingestion, erythema nodosum, erythema multiforme, and spider and snake bites
  • Enteroviruses
  • Infective endocarditis
  • Influenza
  • Leptospirosis
  • Malaria
  • Antiphospholipid antibody syndrome
  • Bernard-Soulier syndrome
  • Bone marrow transplantation
  • Cholestasis
  • Enterococcal infection
  • Hemophilia A, B, and C
  • Kawasaki disease
  • Marfan syndrome
  • Nephrotic syndrome
  • Polyarteritis nodosa
  • Bacterial sepsis - Gonococcemia, Haemophilus influenzae, and Streptococcus pneumoniae infection
  • Anaphylactoid purpura
  • Arboviral infections
  • Capnocytophaga canimorsus infection
  • Marburg virus infection
  • Acute febrile neutrophilic dermatosis (Sweet syndrome)
  • H influenzae meningitis - The H influenzae type B vaccine caused the decline of meningitis related to this bacteria; half of all childhood cases of bacterial meningitis are caused by N meningitidis. Most other cases are due to S pneumoniae.
  • Staphylococcal endocarditis with meningitis [78]