From the Guidelines
The meningitis rash is a critical warning sign that requires immediate medical attention, typically appearing as small, pinpoint red or purple spots (petechiae) that don't fade when pressed with a glass (the "glass test"). As the infection progresses, these spots may enlarge and merge to form larger patches (purpura) or even develop into dark, bruise-like areas (ecchymoses) 1. The rash often starts on the extremities, particularly the hands and feet, but can spread to other parts of the body including the trunk, face, and conjunctiva. Unlike many other rashes, the meningitis rash develops rapidly, sometimes within hours. It's essential to note that not all meningitis cases present with a rash; it's most commonly associated with meningococcal meningitis caused by Neisseria meningitidis. The rash occurs because the bacteria damage blood vessel walls, causing bleeding into the skin. This represents a medical emergency as it indicates the infection has entered the bloodstream (septicemia), which can lead to rapid deterioration, organ failure, and death if not treated promptly with appropriate antibiotics.
Key Characteristics of the Meningitis Rash
- Typically appears as small, pinpoint red or purple spots (petechiae)
- Does not fade when pressed with a glass (the "glass test")
- May enlarge and merge to form larger patches (purpura) or develop into dark, bruise-like areas (ecchymoses)
- Often starts on the extremities, particularly the hands and feet
- Can spread to other parts of the body, including the trunk, face, and conjunctiva
- Develops rapidly, sometimes within hours
Importance of Prompt Medical Attention
The presence of a meningitis rash is a critical warning sign that requires immediate medical attention 1. Urgent hospital referral is mandatory in adults in whom meningitis or meningococcal sepsis is suspected, due to the possibility of rapid deterioration 1. Prompt treatment with appropriate antibiotics is essential to prevent rapid deterioration, organ failure, and death. It's crucial to note that the clinical features of meningitis can be non-specific, and the presence of a rash is a key indicator of meningococcal sepsis 1.
From the Research
Characteristics of a Meningitis Rash
- The rash associated with meningitis is often petechial or purpuric in nature 2, 3, 4, 5
- It may appear as small, pinpoint spots or larger patches, and can be found on various parts of the body, including the abdomen, trunk, and extremities 3, 5
- The rash is typically non-blanching, meaning it does not fade when pressed 5
- In some cases, the rash may be accompanied by other symptoms such as fever, headache, and nuchal rigidity 2, 3, 5
- The presence of a non-blanching rash, particularly in combination with other symptoms such as fever and delayed capillary refill, can be a strong indicator of meningococcal infection 5
Types of Rashes Associated with Meningitis
- Petechial rash: a rash characterized by small, pinpoint spots 2, 3, 4
- Purpuric rash: a rash characterized by larger, more pronounced patches 3, 5
- Hemorrhagic rash: a rash characterized by bleeding into the skin 3
Diagnostic Considerations
- The presence of a non-blanching rash, particularly in combination with other symptoms such as fever and delayed capillary refill, can be a strong indicator of meningococcal infection 5
- Laboratory investigations, such as blood cultures and cerebrospinal fluid analysis, can help confirm the diagnosis of meningococcal infection 2, 3, 6
- Measurement of C reactive protein may be helpful in distinguishing between meningococcal and non-meningococcal infections 5