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Potentially life-threatening emergency
Acute meningococcemia in Infant/Neonate
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Acute meningococcemia in Infant/Neonate

Contributors: Craig N. Burkhart MD, Dean Morrell MD
Other Resources UpToDate PubMed


Meningococcal disease is a rapidly progressive infection caused by Neisseria meningitides, a Gram-negative diplococcus bacterium. Infection begins as a nonspecific viral-like illness that rapidly evolves (within hours) into one of two main presentations: meningitis or septicemia. Apart from epidemics, meningococcal disease occurs sporadically, most commonly during the winter months, often following outbreaks of influenza. Most cases are acquired through exposure to asymptomatic carriers via respiratory droplets. Although severe disease has a mortality approaching 50%, early recognition and aggressive management can reduce the mortality to less than 5%.

Complications of acute meningococcemia include pericarditis/myocarditis, disseminated intravascular coagulation (DIC), meningitis and permanent neurologic sequelae, septic arthritis, osteomyelitis, adrenal hemorrhage (Waterhouse-Friderichsen syndrome), gangrene, and death.

Risk factors for meningococcal disease include viral infections, smoke exposure, crowded living conditions, underlying chronic diseases, and low socioeconomic status. Infants with primary or acquired deficiencies of terminal complement components or asplenia are also at increased risk of meningococcal disease.

Related topic: Chronic Meningococcemia


A39.2 – Acute meningococcemia

186365005 – Acute meningococcemia

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Differential Diagnosis & Pitfalls

Multiple other diseases associated with vascular injury must be differentiated from meningococcal disease. Patients with congenital (clotting defects) or immune (Leukocytoclastic vasculitis) causes of purpura and ecchymoses rarely have cardiovascular compromise. The large ecchymoses of meningococcal disease also tend to be well-defined, superficial, and have overlying necrosis, whereas large ecchymoses associated with clotting factor deficiencies or trauma are usually ill-defined, subcutaneous, and are not associated with necrosis. Nonspecific Viral exanthem usually appear after a prodrome of several days, whereas patients with meningococcemia typically develop a rash in less than 24 hours of onset of an acute illness. Petechiae caused by coughing, crying, or vomiting are confined to the distribution of the superior vena cava (head, neck, and chest above the nipple line), whereas petechiae associated with meningococcemia are located over the entire torso and extremities.

  • Bacterial sepsis or meningitis (Streptococcus pneumoniae, Invasive Haemophilus influenzae infection, Staphylococcus aureus, group A streptococcus, other Gram-negative cocci or bacilli)
  • Viral illness (ie, hemorrhagic fever group, Disseminated herpes simplex virus (HSV), Varicella (VZV), Cytomegalovirus infection (CMV), Echovirus infection, Coxsackie viral infection)
  • Rickettsiae (Rocky Mountain spotted fever, Ehrlichiosis, Epidemic typhus)
  • Atypical measles
  • Disseminated fungal infection
  • Leptospirosis
  • Dengue fever
  • Early congenital syphilis
  • Brazilian purpuric fever
Autoimmune Vasculitis
  • Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
  • Acute hemorrhagic edema of infancy
  • Kawasaki disease
  • Leukocytoclastic vasculitis
  • Drug-induced non-palpable purpura
  • Toxic shock syndrome
  • Heparin necrosis
  • Hemolytic uremic syndrome
  • Serum sickness
  • Immune thrombocytopenic purpura
  • Protein C deficiency or Protein S deficiency
  • Petechiae caused by coughing, vomiting, or crying
  • Traumatic purpura

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Last Updated:10/02/2019
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Acute meningococcemia in Infant/Neonate
A medical illustration showing key findings of Acute meningococcemia : Altered mental state, Headache, Vomiting, Mottled configuration, Ecchymosis, Myalgia, Nuchal rigidity, High fever, WBC elevated
Clinical image of Acute meningococcemia - imageId=273564. Click to open in gallery.  caption: 'Widespread petechiae and purpura, some with deep gunmetal gray centers (signifying necrosis), on the arm.'
Widespread petechiae and purpura, some with deep gunmetal gray centers (signifying necrosis), on the arm.
Copyright © 2024 VisualDx®. All rights reserved.