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