By Gary M. White, MD
Meningococcemia is an infection by Neisseria meningitidis. The classic patient is a young person with fever, severe headache, nausea, vomiting and a stiff neck. Rapid obtundation and death may occur.
The classic rash of acute meningococcemia is petechial along the distal extremities.
Rarely, chronic infection by meningococcus may occur and is defined as meningococcal sepsis of at least 1 week's duration without meningeal symptoms. It is characterized by a prolonged course of the disease with intermittent fever, frontal headaches, migratory arthralgia, and recurrent or persistent rash. In between the febrile episodes, the patient is often completely well. The cutaneous manifestations, which are observed in up to 90% of cases, are variable and include maculopapular (47.6%), nodular (13.1%), petechial (11.9%), and polymorphous (27.4%) lesions [Am J Med 1963;35:103–112].
Aggressive therapy in the emergency room is essential. Consultation with an infectious disease expert is in order. In the past, IV penicillin or other appropriate antibiotic has been recommended along with other supportive measures. Rifampin has been given as a prophylaxis for close contacts.
Courtesy O. Dale Collins, MD
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