Abstract
FULMINANT MENINGOCOCCEMIA

*Dr. Madleen Jawad Sobhe Abu Aser and Dr. Amjad Alanqar

ABSTRACT

Meningococcemia a bacterial infection of the blood due to Neisseria meningitides also called meningococcal bacteremia or meningococcal sepsis. As the name suggests, this bacterium is best known for causing meningococcal meningitis, which occurs in up to 20% of those with meningococcemia. Up to 75% of those with meningococcal meningitis will also have bacteremia. Purpura fulminans, an often-fatal condition owing to the associated septic shock. These two clinical aspects of the meningococcal infection are consequences of a tight interaction of meningococcal with host endothelial cells. This interaction, mediated by the type IV pili, is responsible for the formation of microcolonies on the apical surface of the cells. This interaction is followed by the activation of signaling pathways in the host cells leading to the formation of a microbiological synapse. A low level of bacteremia is likely to favor the colonization of brain vessels, leading to bacterial meningitis, whereas the colonization of a large number of vessels by a high number of bacteria is responsible for one of the most severe forms of septic shock observed. Neisseria meningococcus is a Gram-negative coccus restricted to humans, which is responsible for two major diseases cerebrospinal meningitis and/or septicemia. Paradoxically, N. meningitides is a common inhabitant of the human nasopharynx, and as such is a normal, saprophytic organism that is transmitted from person to person by direct contact. Only in a small proportion of colonized subjects does the bacterium invade the bloodstream where they are responsible for septicemia and/or meningitis, after crossing of the blood-brain barrier. Fulminant meningococcemia accounts for 5% to 10% of patients with meningococcemia; it is rapidly progressive and is associated with high morbidity and mortality rates. The highest meningococcal incidence is found in the 6- to 20-month-old age group; whereas immunouncompetence is suggested in adults with the condition. Coincidentally, eating disorders are purported to be the most prevalent psychiatric or behavioral disturbance affecting adolescents, and studies indicate that vulnerability to infectious. Meningococcal disease caused by the gram-negative diplococcus Neisseria meningitides is a relatively common infectious disease in developing countries of Asia and Africa. Infection usually starts with a non-specific prodromal of fever, vomiting, malaise, and lethargy followed by signs of septicemia and shock tachycardia, tachypnea, cyanosis, oliguria, hypotension or meningitis stiff neck, headache, photophobia, and impaired sensorium. Neisseria meningitides is responsible for two major diseases: cerebrospinal meningitis or septicemia. The latter can lead to a purpura fulminans, an often-fatal condition owing to the associated septic shock. These two clinical aspects of the meningococcal infection are consequences of a tight interaction of meningococci with host endothelial cells. This interaction is followed by the activation of signaling pathways in the host cells leading to the formation of a microbiological synapse. A low level of bacteremia is likely to favor the colonization of brain vessels, leading to bacterial meningitis, whereas the colonization of a large number of vessels by a high number of bacteria is responsible for one of the most severe forms of septic shock observed. A 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 fulminant 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 an appropriate antibiotic.

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