Meningococcemia physical examination: Difference between revisions
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{{Meningococcemia}} | {{Meningococcemia}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}} | {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; {{Ammu}} | ||
==Overview== | |||
Physical examination may show [[fever]], [[hypotension]], [[petechial rash]], conjuctival congestion, [[nuchal rigidity]], [[seizures]], [[edema]], hepatosplenomegaly, [[dyspnea]] and [[rales]]. | |||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
One of four scenarios is often present: | |||
One of | #Bacteremia without sepsis. Admission for upper respiratory illness or viral exanthem. Positive blood cultures for ''[[Neisseria meningitidis]]''. | ||
#Bacteremia without sepsis. Admission for upper respiratory illness or viral exanthem. Positive blood cultures for ''Neisseria | #Meningococcemia without [[meningitis]]. Septic patient with [[leukocytosis]], skin rashes, generalized [[malaise]], [[weakness]], [[headache]], and [[hypotension]] on admission or shortly after. | ||
#Meningococcemia without meningitis. Septic patient with leukocytosis, skin rashes, generalized malaise, weakness, headache, and hypotension on admission or shortly after. | #Meningitis with or without meningococcemia. Patients with [[headache]], [[fever]], [[meningeal signs]] and cloudy spinal fluid. No pathologic reflexes. | ||
#Meningitis with or without meningococcemia. Patients with headache, fever, meningeal signs and cloudy spinal fluid. No pathologic reflexes. | #Meningoencephalitic presentation. Profoundly obtunded with [[meningeal signs]] and septic [[spinal fluid]]. Altered reflexes (either absent or rarely hyperactive). Pathologic reflexes are often present.<ref name=CDC>{{cite web | title = The Centers for Disease Control and Prevention(CDC)| url=http://www.cdc.gov/meningococcal/about/diagnosis-treatment.html}}</ref> | ||
#Meningoencephalitic presentation. Profoundly obtunded with meningeal signs and septic spinal fluid. Altered reflexes (either absent or rarely hyperactive). Pathologic reflexes are often present. | |||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Fever]] | *[[Fever]] | ||
*Not infrequently [[hypotension]] and [[shock]] | *Not infrequently [[hypotension]] and [[shock]] | ||
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* Petechial [[rash]] manifesting as discrete lesions 1-2 mm in diameter frequently on the trunk and lower portions of the body. | * Petechial [[rash]] manifesting as discrete lesions 1-2 mm in diameter frequently on the trunk and lower portions of the body. | ||
* Petechial regions can coalesce and form larger lesions that appear ecchymotic. | * Petechial regions can coalesce and form larger lesions that appear ecchymotic. | ||
* A rash may appear that mimics a viral exanthem, particularly [[rubella]]. Not purpuric and non-pruritis and is transient, generally not lasting more than 2 days and is frequently gone hours after first observation. | * A [[rash]] may appear that mimics a viral exanthem, particularly [[rubella]]. Not purpuric and non-pruritis and is transient, generally not lasting more than 2 days and is frequently gone hours after first observation. | ||
=== Eyes === | === Eyes === | ||
| Line 28: | Line 29: | ||
=== Lungs === | === Lungs === | ||
[[Rales]] may be present | *[[Rales]] may be present | ||
* Consolidation may be present (if [[pneumonia]] is present). | |||
=== Neurologic === | === Neurologic === | ||
Nuchal rigidity and seizures may be present | [[Nuchal rigidity]] and [[seizures]] may be present. | ||
==Gallery== | |||
{| | |||
|[[File: Meningitis_01.png|thumb|250px|Purpuric rash <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=287}}</ref></small></small>]] | |||
|[[File: Meningitis_02.jpg|thumb|250px| Purpuric rash. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=287}}</ref></small></small>]] | |||
|[[File:Meningococcemia Rash.jpg|thumb|250px|4 month old female with gangrene of hands and lower extremities due to meningococcemia <br><small> Image obtained from CDC Public Health Image Library (ID#1335)</small>]] | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Dermatology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Hematology]] | |||
[[Category:Neurology]] | |||
[[Category:Pediatrics]] | |||
[[Category:Medicine]] | |||
[[Category:Disease]] | |||
[[Category:Bacterial diseases]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 18:03, 18 September 2017
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Meningococcemia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Meningococcemia physical examination On the Web |
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American Roentgen Ray Society Images of Meningococcemia physical examination |
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Risk calculators and risk factors for Meningococcemia physical examination |
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
Physical examination may show fever, hypotension, petechial rash, conjuctival congestion, nuchal rigidity, seizures, edema, hepatosplenomegaly, dyspnea and rales.
Physical Examination
Appearance of the Patient
One of four scenarios is often present:
- Bacteremia without sepsis. Admission for upper respiratory illness or viral exanthem. Positive blood cultures for Neisseria meningitidis.
- Meningococcemia without meningitis. Septic patient with leukocytosis, skin rashes, generalized malaise, weakness, headache, and hypotension on admission or shortly after.
- Meningitis with or without meningococcemia. Patients with headache, fever, meningeal signs and cloudy spinal fluid. No pathologic reflexes.
- Meningoencephalitic presentation. Profoundly obtunded with meningeal signs and septic spinal fluid. Altered reflexes (either absent or rarely hyperactive). Pathologic reflexes are often present.[1]
Vital Signs
- Fever
- Not infrequently hypotension and shock
Skin
- Petechial rash manifesting as discrete lesions 1-2 mm in diameter frequently on the trunk and lower portions of the body.
- Petechial regions can coalesce and form larger lesions that appear ecchymotic.
- A rash may appear that mimics a viral exanthem, particularly rubella. Not purpuric and non-pruritis and is transient, generally not lasting more than 2 days and is frequently gone hours after first observation.
Eyes
- Palpebral and ocular conjunctival petechia.
Heart
- Congestive heart failure, myocarditis, pericarditis may be present
Lungs
Neurologic
Nuchal rigidity and seizures may be present.
Gallery
 |
 |
 Image obtained from CDC Public Health Image Library (ID#1335) |