From the Guidelines
Meningococcemia presents with distinct signs and symptoms, including sudden onset of fever, headache, and general malaise, followed by a characteristic rash, severe muscle pain, cold hands and feet, abnormal skin color, neck stiffness, photophobia, confusion, and lethargy, which can rapidly progress to life-threatening illness within hours. The infection often starts with flu-like symptoms, but as it progresses, a purpuric or petechial rash typically develops, which is a hallmark of meningococcal sepsis 1. Other symptoms may include septic shock with hypotension, tachycardia, and decreased urine output, as well as disseminated intravascular coagulation (DIC), multi-organ failure, or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) 1.
Key Signs and Symptoms
- Sudden onset of fever, headache, and general malaise
- Characteristic rash, which begins as small, pink macules that rapidly evolve into purple, non-blanching petechiae or purpura
- Severe muscle pain
- Cold hands and feet
- Abnormal skin color
- Neck stiffness
- Photophobia
- Confusion
- Lethargy
- Septic shock with hypotension, tachycardia, and decreased urine output It is essential to seek emergency medical care immediately if meningococcemia is suspected, as early intervention significantly improves survival rates 1. Critical care input should be sought early in patients with risk factors for a poor outcome, especially persistent seizures, and hypoxia 1. Patients with meningococcal sepsis are typically young adults, who tend to maintain their blood pressure until late in disease, and then deteriorate rapidly, making it crucial to monitor them frequently for signs of cardiac instability and impaired perfusion, such as delayed capillary refill time, and dusky or cold extremities 1.
From the Research
Signs and Symptoms of Meningococcemia
The signs and symptoms of meningococcemia can vary, but common presentations include:
- Fever [(2,3,4,5,6)]
- Rash, which can be petechial or purpuric [(2,3,4,5)]
- Abdominal pain [(2,4,6)]
- Arthralgias and myalgias 2
- Generalized weakness [(4,5)]
- Hypotension [(2,4)]
- Tachycardia 2
- Meningitis [(2,5)]
- Sepsis [(2,3,5)]
Less Common Presentations
In some cases, meningococcemia can present with less common symptoms, such as:
- Gastroenteritis-like syndrome, with diarrhea and vomiting 6
- Immune-mediated arthritis 4
- Myocarditis 2
- Coagulopathy 2
- Peripheral gangrene 2
Importance of Prompt Diagnosis
Prompt diagnosis and treatment of meningococcemia are crucial for prognosis [(2,3,5)]. The use of parenteral antibiotics, such as penicillin, can help stabilize and recover patients 2. Surveillance and prevention measures, including chemoprophylaxis and vaccination, are also important in preventing secondary cases of meningococcal disease 5.