Meningococcemia

■ Synonyms: Waterhouse-Friderichsen syndrome (with purpura fulminans and adrenal hemorrhage)

■ Etiology: Invasive infection with Neisseria meningitidis

■ Associations: Inherited or acquired deficiencies of complement or immunoglobulin in some cases

■ Clinical: Upper respiratory tract symptoms, then fever, myalgias, arthralgias; cutaneous involvement—macules, papules, petechiae, palpable purpura; purpuric necrotic patches of purpura fulminans

■ Histology: Skin biopsy with mixed lymphocyte and neutrophil infiltrate,

±vasculitis, organism may be found by Gram's stain

■ Evaluation: Blood cultures, CBC with differential, platelets, PT/PTT, other coagulation parameters, Gram's stain of smears from purpuric lesions

■ Treatment: Intravenous antibiotics—penicillin G or third generation cephalosporin, fluid and inotropic support; ± activated protein C infusion or bactericidal permeability increasing protein for severe sepsis

■ Prognosis: Good if treated early, but guarded with signs of sepsis or purpura fulminans

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