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Meningococcemia

Meningococcemia is a disease caused by the gram-negative diplococci Neisseria meningitidis and usually is seen in young people (under 20 years old). This infection can cause pharyngitis, meningitis, sepsis, or a combination of CNS and systemic infection. Infection usually begins 3 to 4 days after exposure and can rapidly progress from very mild symptoms to death in a few hours.

Causes

Neisseria meningitidis frequently lives in the upper respiratory tract with no evidence of illness. Some event is thought to trigger the onset of aggressive behavior of the organism and sporadic cases of meningococcemia and meningococcal meningitis appear

In children over 3 to 4 months, the main bacteria that cause meningitis are:

  • The most common bacteria streptococcus pneumoniae
  • Hemophilus Influenzae
  • Neisseria meningococcus

The bacteria, Streptococcus pneumoniae and Hemophilus influenzae are the main bacterial causes of ear and other respiratory infections including pneumonia and sinusitis. Menigococcus has been the cause of the recent outbreaks of "meningitis".

Symptoms

  • Rash
  • Headache
  • Fever
  • Nausea
  • Sore throat
  • Vomiting
  • Myalgias
  • Arthralgias
  • Stiff neck
  • Confusion

Signs

  • Rash classically begins as petechiae (extremities, trunk, palms, soles, head, and mucous membranes).
  • Petechiae develop into palpable purpura with gray necrotic centers.
  • Rash can also manifest as urticaria, hemorrhagic vesicles, macules, and maculopapules.
  • Occasionally presentation as fulminant meningococcal disease characterized by shock, with petechial and ecchymotic areas ++. Purpura fulminans, a severe form of disseminated intravascular coagulation, may develop in these patients. Some affected ecchymotic areas become necrotic and gangrenous and must be amputated.

Treatment

Immediate treatment of a suspected case of meningococcemia begins with antibiotics that work against the organism. Possible choices such as includes:

  • Penicillin G
  • Ceftriaxone (Rocephin)
  • Cefotaxime (Claforan)
  • Trimethoprim

The patient is diagnosed in a doctor's office, antibiotics should be given immediately if possible, even before transfer to the hospital and even if cultures cannot be obtained before treatment. It is likely that the speed of initial treatment will affect the ultimate outcome.

   
   

 
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