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Potentially life-threatening emergency
Acute meningococcemia in Infant/Neonate
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Potentially life-threatening emergency

Acute meningococcemia in Infant/Neonate

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Contributors: Craig N. Burkhart MD, Dean Morrell MD
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Synopsis

Acute meningococcemia : Altered mental state, Headache, Vomiting, Mottled configuration, Ecchymosis, Myalgia, Nuchal rigidity, High fever, WBC elevated
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

Codes

ICD10CM:
A39.2 – Acute meningococcemia

SNOMEDCT:
186365005 – Acute meningococcemia

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Diagnostic Pearls

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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 (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 exanthems 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.

Infection
Autoimmune Vasculitis
Toxin/Drug
Hematologic
Physical
  • Petechiae caused by coughing, vomiting, or crying
  • Trauma

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Therapy

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References

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Last Updated:10/02/2019
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Potentially life-threatening emergency
Acute meningococcemia in Infant/Neonate
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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.

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