Alerts and Notices
SynopsisChronic meningococcemia is a rare, recurring, chronic infection of Neisseria meningitidis, which typically presents with an acute febrile illness. Chronic meningococcemia is typically associated with serogroup B N meningitidis. It can affect both adults and children. There are associated myalgias, arthralgias, anorexia, weight loss, and mild headaches that tend to recur cyclically in association with fever. If left untreated, chronic meningococcemia can evolve into life-threatening acute meningococcemia, meningitis, or endocarditis. This disease is more common in individuals lacking a terminal component of the complement pathway, but it has also been described in other individuals who have not been vaccinated against N meningitidis.
Symptoms typically persist for a few days, resolve, and then recur. Afebrile periods can last for days to more than a week. Patients feel healthy between episodes. Skin lesions can be macular, papular, nodular, petechial, or polymorphous. Joint pain typically affects the ankles and knees. Average duration of disease is approximately 1.5-3 months, depending on the case series, and tends to be shorter in children (persisting for 7 weeks to 2 months).
Blood cultures are initially negative in early disease in both children and adults, with earlier positivity on average in children. Thus, blood cultures need to be repeated. Blood culture during febrile periods is thought to be of the highest yield.
A39.3 – Chronic meningococcemia
240426001 – Chronic meningococcemia
Differential Diagnosis & Pitfalls
- Gonococcemia can present similarly and is easily mistaken for chronic meningococcemia.
- Atypical measles
- Cytomegalovirus (CMV) infection
- Thrombotic thrombocytopenic purpura (TTP)
- Rocky Mountain spotted fever
- Acute rheumatic fever
- Still disease
- Noninfectious vasculitis, eg, leukocytoclastic vasculitis
- Lyme disease