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 1 of 2 main presentations: meningitis or septicemia. Most cases are acquired through exposure to asymptomatic carriers via respiratory droplets. Children aged younger than 5 years and teenagers aged 15-19 are predominantly affected.
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.
Related topic: Chronic Meningococcemia
Potentially life-threatening emergency
Acute meningococcemia in Child
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Synopsis
Codes
ICD10CM:
A39.2 – Acute meningococcemia
SNOMEDCT:
186365005 – Acute meningococcemia
A39.2 – Acute meningococcemia
SNOMEDCT:
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 (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
Hematologic
Infection
- Bacteremia or meningitis (Streptococcus pneumoniae, Haemophilus influenzae type b, Staphylococcus aureus, group A streptococcus, other Gram-negative cocci or bacilli)
- Viral illness (ie, hemorrhagic fever group, disseminated herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), echovirus, coxsackievirus)
- Rickettsiae (Rocky Mountain spotted fever, ehrlichiosis, epidemic typhus)
- Atypical measles
- Disseminated fungal infection
- Leptospirosis
- Dengue fever
- Syphilis
- Brazilian purpuric fever
- Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
- Acute hemorrhagic edema of infancy
- Kawasaki disease
- Hypersensitivity vasculitis
Hematologic
- Hemolytic-uremic syndrome
- Serum sickness
- Idiopathic thrombocytopenic purpura
- Protein C or S deficiency
- Petechiae caused by coughing, vomiting, or crying
- Trauma
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Last Updated:10/02/2019
Potentially life-threatening emergency
Acute meningococcemia in Child