What are the symptoms of meningococcemia?

Symptoms of Meningococcemia

Meningococcemia presents most characteristically with fever, petechial or purpuric rash, and signs of septic shock (hypotension, tachycardia), though classic meningeal signs are frequently absent. 1

Key Clinical Presentations

Hemorrhagic Rash (Most Distinctive Feature)

• Petechial or purpuric rash is the hallmark finding, occurring in 20-52% of meningococcal disease cases 1
• When a rash is present in the context of meningitis, meningococcus is the causative organism in over 90% of cases 1
• However, 37% of meningococcal meningitis patients do not have a rash, making its absence unreliable for ruling out disease 1
• A blanching macular or maculopapular rash may appear in the first 24 hours before evolving to petechiae 2

Systemic Manifestations

• Fever is present in 77-97% of cases, though it can be absent, particularly in elderly patients 1
• Abrupt onset of illness with rapid evolution is characteristic 3, 2
• Severe prostration, hypotension, and tachycardia develop early 3
• True rigors are a useful early clinical clue 2

Meningeal vs. Septicemic Presentations

• Meningococcemia without meningitis accounts for 15-20% of cases and carries the worst prognosis 2
• When meningitis is present, headache (58-87%), neck stiffness (65-83%), and altered mental status (30-69%) may occur 1
• The classic triad of fever, neck stiffness, and altered mental status is present in only 41-51% of bacterial meningitis cases 1
• Concomitant septic shock occurs in approximately 25% of meningitis cases 1

Pain Symptoms

• Severe pain in extremities, neck, or back is an important early clue 2
• Arthralgias, myalgias, and abdominal pain are common nonspecific prodromal symptoms 3
• Vomiting, especially in association with headache or abdominal pain, should raise suspicion 2

Critical Diagnostic Pitfalls

Do Not Rely on Meningeal Signs

• Neck stiffness has only 31% sensitivity in adults 1
• Kernig's and Brudzinski's signs have very low sensitivity (5-11%) and should not be used to rule out meningococcemia 1, 4
• These physical examination findings have poor diagnostic accuracy and their absence cannot exclude disease 1

Age-Related Variations

• Elderly patients are more likely to have altered consciousness and less likely to have neck stiffness or fever compared to younger patients 1, 4
• Highest incidence occurs at age 3-12 months, followed by 1-4 years and 15-19 years 2

Rapid Progression

• Meningococcemia can progress from initial symptoms to coma and death in 12-48 hours if untreated 5
• Most deaths occur within the first 24 hours 3
• Patients may require mechanical ventilation and vasopressor support within 24 hours of diagnosis 3

Severe Complications

• Disseminated intravascular coagulation (DIC) 3, 6
• Multiple organ failure 6
• Myocarditis with ECG and echocardiographic abnormalities 3
• Peripheral gangrene requiring surgical intervention 3
• Seizures (10-56% in children, 19-25% overall) 1
• Focal neurologic deficits (11-34%) 1

Clinical Decision-Making

When evaluating any acutely febrile patient, ask: "Why is this patient seeking help now?" and "Could this patient have meningococcemia?" 2

Indications for Urgent Hospital Referral

• All patients with suspected meningococcemia require immediate hospital admission via emergency ambulance, ideally arriving within one hour 1
• The presence of any combination of fever, rash (of any description), altered mental status, headache, severe pain, or signs of shock mandates urgent evaluation 1, 2
• Concern expressed by parents, relatives, or friends should be taken seriously as an important clinical clue 2

Essential Documentation

• Document presence or absence of: headache, altered mental status, neck stiffness, fever, rash, seizures, and signs of shock (hypotension, poor capillary refill) 1
• Never delay antibiotic therapy while awaiting diagnostic confirmation, as mortality remains high in untreated disease 7, 3