Meningococcemia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Ammu Susheela, M.D. [3]
Overview
Every child with purpuric rash and high fever should be treated as meningococcemia until proven otherwise. The history suggest patient with high fever, rash, headache, myalgia and stiff neck.
History and Symptoms
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The following are some of the symptoms found in meningococcus infection. Not all of these symptoms will appear, and not necessarily in this order. Every child with purpuric rash and high fever should be treated as meningococcemia - until proven otherwise.
- Headache, confusion, and stiff neck occurred as symptoms in less than half of 53 patient in one series by Carpenter and Petersdorf.
- High fever
- Mental status changes
- Nausea and vomiting
- Patient may complain of significant myalgias.
- Rash, pinpoint red spots (petechiae)
- Sensitivity to light (photophobia)
- Severe headache
- Severe malaise
- Stiff neck
- Meningitis is the most common presentation of invasive meningococcal disease and results from hematogenous dissemination of the organism.
- Meningeal infection is similar to other forms of acute purulent meningitis, with sudden onset of fever, headache, and stiff neck, often accompanied by other symptoms, such as nausea, vomiting, photophobia (eye sensitivity to light), and altered mental status. Meningococci can be isolated from the blood in up to 75% of persons with meningitis.
- Meningococcal sepsis (bloodstream infection or meningococcemia) occurs without meningitis in 5% to 20% of invasive meningococcal infections. This condition is characterized by abrupt onset of fever and a petechial or purpuric rash, often associated with hypotension, shock, acute adrenal hemorrhage, and multiorgan failure.
- Less common presentations of meningococcal disease include pneumonia (5% to 15% of cases), arthritis (2%), otitis media (1%), and epiglottitis (less than 1%).[2]
Case Definition
The following definitions can be used to describe a case of meningococcal disease: [4]
- Confirmed case: A confirmed case of meningococcal disease is defined by isolation of N. meningitidis from a normally sterile site (e.g., blood or CSF) from a person with clinically compatible illness.
- Probable case: A probable case of meningococcal disease is defined by detection of N. meningitidis DNA by polymerase chain reaction or polysaccharide antigen in CSF (e.g., by latex agglutination or immunohistochemistry), or the presence of clinical purpura fulminans in the absence of diagnostic culture from a person with clinically compatible disease.
- Primary case: A primary case of meningococcal disease is one that occurs in the absence of previous known close contact with another patient with meningococcal disease.
- Secondary case: A secondary case of meningococcal disease is one that occurs among close contacts of a primary case-patient 24 hours or more after onset of illness in the primary patient.
- Co-primary case: Co-primary cases are two or more cases that occur among a group of close contacts with onset of illness separated by less than 24 hours.
- Close contacts: Close contacts of a patient who has meningococcal disease include: household members (including dormitory room, barracks), child care center contacts, and persons directly exposed to the patient’s oral secretions (e.g., by kissing, mouth-to-mouth resuscitation, endotracheal intubation, or endotracheal tube management).
