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

[(http://commons.wikimedia.org/wiki/File:Symptoms_of_Meningitis.svg)]

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

HUSSEIN AND SHAFRAN CANADIAN REVIEW OF BACTERIAL MENINGITIS

Fever >= 37.7 degrees Celsius	97%
Nucal Rigidity	87%
Headache	66%
Denied Headache	16%
Nausea/Vomiting	55%
Confusion	56%
Decreased Consciousness	51%
Focal Neurologic Deficits	23%
Seizure	29%

• 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%).

[(http://www.cdc.gov/meningococcal/)]