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Meningococcal disease: a case report and discussion of clinical presentation and management

Year 2012, Volume: 17 Issue: 1, 40 - 45, 24.01.2013

Abstract

Abstract. Meningococcal disease caused by the gram negative diplococcus Neisseria meningitidis is a relatively common infectious disease in developing countries of Asia and Africa. Infection usually starts with a non-specific prodrome of fever, vomiting, malaise and lethargy followed by signs of septicemia and shock (tachycardia, tachypnea, cyanosis, oliguria, hypotension) and/or meningitis (stiff neck, headache, photophobia and impaired sensorium). Characteristic meningococcal rash may not appear early in the disease course, potentially delaying the diagnosis and institution of appropriate antibiotic therapy in the patient and isolation and chemoprophylaxis in close contacts. We present here a patient who presented with meningococcal shock associated with characteristic skin lesions of meningococcemia and discuss the clinical presentation and management.  The importance of early identification of the characteristic skin lesions of meningococcemia and timely institution of appropriate antibiotic therapy is emphasized.

Key words: Meningitis, meningococcal meningitis, meningococcal septicemia,  meningococcal shock syndrome


References

  • Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007; 369: 2196-2210.
  • Nair D, Dawar R, Deb M, et al. Outbreak of meningococcal disease in and around New Delhi, India, 2005-2006: a report from a tertiary care hospital. Epidemiol Infect 2009; 137: 570-576.
  • Stein-Zamir C, Abramson N, Zentner G, et al. Invasive meningococcal disease in children in Jerusalem. Epidemiol Infect 2008; 136: 782-789.
  • Saha R, Gadre D, Mathur M. Meningococcaemia: experience at a tertiary care hospital in East Delhi. Indian J Med Microbiol 2006; 24: 299-300.
  • Shah A, Lettieri CJ. Fulminant meningococcal sepsis in a woman with previously unknown hyposplenism. Medscape J Med 2008; 10: 36.
  • Van Deuren M, van Dijke BJ, Koopman RJ, et al. Rapid diagnosis of acute meningococcal infections by needle aspiration or biopsy of skin lesions. BMJ 1993; 306: 1229-1232.
  • Yung AP, McDonald MI. Early clinical clues to meningococcaemia. Med J Aust 2003; 178: 134-137.
  • London V, Aronowitz P. Purpuric rash of meningococcemia. J Hosp Med 2008; 3: 169.
  • Hachimi-Idrissi S, Corne L, Ramet J. Evaluation of scoring systems in acute meningococcaemia. Eur J Emerg Med 1998; 5: 225-230.
  • Visintin C, Mugglestone MA, Fields EJ, et al. Guideline Development Group; National Institute for Health and Clinical Excellence. Management of bacterial meningitis and meningococcal septicemia in children and young people: summary of NICE guidance. BMJ 2010; 340: c3209. doi: 10.1136/bmj.c3209.
  • Van Waardenburg DA, Jansen TC, Vos GD, Buurman WA. Hyperglycemia in children with meningococcal sepsis and septic shock: the relation between plasma levels of insulin and inflammatory mediators. J Clin Endocrinol Metab 2006; 91: 3916-3921.
  • Branco RG, Russell RR. Should steroids be used in children with meningococcal shock? Arch Dis Child 2005; 90: 1195-1196.
  • van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol 2010; 9: 254-263.
  • de Gans J, van de Beek D. European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549-1556.
  • Wildes SS, Tunkel AR. Meningococcal vaccines: a progress report. BioDrugs 2002; 16: 321-329.
  • Shao ZJ, Li YX. Study progress on serogroup B meningococcal vaccine. Zhongguo Yi Miao He Mian Yi 2009; 15: 542-546.
  • Tan LKK, Carlone GM, Borrow R. Advances in the development of vaccines against Neisseria meningitidis. N Engl J Med 2010; 362: 1511-1520.
Year 2012, Volume: 17 Issue: 1, 40 - 45, 24.01.2013

Abstract

References

  • Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007; 369: 2196-2210.
  • Nair D, Dawar R, Deb M, et al. Outbreak of meningococcal disease in and around New Delhi, India, 2005-2006: a report from a tertiary care hospital. Epidemiol Infect 2009; 137: 570-576.
  • Stein-Zamir C, Abramson N, Zentner G, et al. Invasive meningococcal disease in children in Jerusalem. Epidemiol Infect 2008; 136: 782-789.
  • Saha R, Gadre D, Mathur M. Meningococcaemia: experience at a tertiary care hospital in East Delhi. Indian J Med Microbiol 2006; 24: 299-300.
  • Shah A, Lettieri CJ. Fulminant meningococcal sepsis in a woman with previously unknown hyposplenism. Medscape J Med 2008; 10: 36.
  • Van Deuren M, van Dijke BJ, Koopman RJ, et al. Rapid diagnosis of acute meningococcal infections by needle aspiration or biopsy of skin lesions. BMJ 1993; 306: 1229-1232.
  • Yung AP, McDonald MI. Early clinical clues to meningococcaemia. Med J Aust 2003; 178: 134-137.
  • London V, Aronowitz P. Purpuric rash of meningococcemia. J Hosp Med 2008; 3: 169.
  • Hachimi-Idrissi S, Corne L, Ramet J. Evaluation of scoring systems in acute meningococcaemia. Eur J Emerg Med 1998; 5: 225-230.
  • Visintin C, Mugglestone MA, Fields EJ, et al. Guideline Development Group; National Institute for Health and Clinical Excellence. Management of bacterial meningitis and meningococcal septicemia in children and young people: summary of NICE guidance. BMJ 2010; 340: c3209. doi: 10.1136/bmj.c3209.
  • Van Waardenburg DA, Jansen TC, Vos GD, Buurman WA. Hyperglycemia in children with meningococcal sepsis and septic shock: the relation between plasma levels of insulin and inflammatory mediators. J Clin Endocrinol Metab 2006; 91: 3916-3921.
  • Branco RG, Russell RR. Should steroids be used in children with meningococcal shock? Arch Dis Child 2005; 90: 1195-1196.
  • van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol 2010; 9: 254-263.
  • de Gans J, van de Beek D. European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549-1556.
  • Wildes SS, Tunkel AR. Meningococcal vaccines: a progress report. BioDrugs 2002; 16: 321-329.
  • Shao ZJ, Li YX. Study progress on serogroup B meningococcal vaccine. Zhongguo Yi Miao He Mian Yi 2009; 15: 542-546.
  • Tan LKK, Carlone GM, Borrow R. Advances in the development of vaccines against Neisseria meningitidis. N Engl J Med 2010; 362: 1511-1520.
There are 17 citations in total.

Details

Primary Language English
Journal Section Case Report
Authors

Pk Sethi This is me

R Thukral This is me

Nk Sethi This is me

J Torgovnick This is me

E Arsura This is me

A Wasterlain This is me

Publication Date January 24, 2013
Published in Issue Year 2012 Volume: 17 Issue: 1

Cite

APA Sethi, P., Thukral, R., Sethi, N., Torgovnick, J., et al. (2013). Meningococcal disease: a case report and discussion of clinical presentation and management. EASTERN JOURNAL OF MEDICINE, 17(1), 40-45.
AMA Sethi P, Thukral R, Sethi N, Torgovnick J, Arsura E, Wasterlain A. Meningococcal disease: a case report and discussion of clinical presentation and management. EASTERN JOURNAL OF MEDICINE. March 2013;17(1):40-45.
Chicago Sethi, Pk, R Thukral, Nk Sethi, J Torgovnick, E Arsura, and A Wasterlain. “Meningococcal Disease: A Case Report and Discussion of Clinical Presentation and Management”. EASTERN JOURNAL OF MEDICINE 17, no. 1 (March 2013): 40-45.
EndNote Sethi P, Thukral R, Sethi N, Torgovnick J, Arsura E, Wasterlain A (March 1, 2013) Meningococcal disease: a case report and discussion of clinical presentation and management. EASTERN JOURNAL OF MEDICINE 17 1 40–45.
IEEE P. Sethi, R. Thukral, N. Sethi, J. Torgovnick, E. Arsura, and A. Wasterlain, “Meningococcal disease: a case report and discussion of clinical presentation and management”, EASTERN JOURNAL OF MEDICINE, vol. 17, no. 1, pp. 40–45, 2013.
ISNAD Sethi, Pk et al. “Meningococcal Disease: A Case Report and Discussion of Clinical Presentation and Management”. EASTERN JOURNAL OF MEDICINE 17/1 (March 2013), 40-45.
JAMA Sethi P, Thukral R, Sethi N, Torgovnick J, Arsura E, Wasterlain A. Meningococcal disease: a case report and discussion of clinical presentation and management. EASTERN JOURNAL OF MEDICINE. 2013;17:40–45.
MLA Sethi, Pk et al. “Meningococcal Disease: A Case Report and Discussion of Clinical Presentation and Management”. EASTERN JOURNAL OF MEDICINE, vol. 17, no. 1, 2013, pp. 40-45.
Vancouver Sethi P, Thukral R, Sethi N, Torgovnick J, Arsura E, Wasterlain A. Meningococcal disease: a case report and discussion of clinical presentation and management. EASTERN JOURNAL OF MEDICINE. 2013;17(1):40-5.