Gram neg diplococci Respiratory droplets Prevented by Men C vaccine ?
Non-blanching purpuric rash on the trunk and extremities, which may be preceded by a blanching maculopapular rash, and can rapidly progress to ecchymoses, haemorrhagic bullae and tissue necrosis
Diagnosis of meningococcal septiceamia = blood cultures but NO TIME Diagnosis of rash – glass test, not specific. Pt – Patient will be unwell and pyrexial Sept. Signs eg decreased cap refill, cold perophs, BP falls LATE
Through Upreg. of adhesion molecules on endothelium and degranulating activated neutrophils ...microthrombi Ecchymosis = Bruising The passage of blood from ruptured blood vessels into subcutaneous tissue, marked by a purple discoloration of the skin. haemorrhages and microthrombi in small vessels, consistent with a generalized Sanarelli-Shwartzman reaction. Hypercoagulability was demonstrated in some patients. local Shwartzman reaction, but that immunological factors probably contribute to pathogenesis. Shwartzman phenomenon, Shwartzman reaction, Shwartzman-Sanarelli reaction a reaction to a second dose of bacterial endotoxin. It may be a local tissue reaction characterized by thrombosis, infarction and hemorrhagic necrosis, or generalized with disseminated intravascular coagulation and bilateral renal cortical necrosis.
Local guidelines for hospital Ax use – cefotaxime 2mg/6h slow IV advised OHCM Do not attempt LP Get help from critical care, if shocked to ICU, if not then careful monitoring Notifiable disease Contacts – rifampicin or ciprofloxacin prophylaxis (ideally within 14 days of exposure)
Although DIC is a generalized phenomenon affecting all organs, the adrenals are particularly vulnerable. Adrenal haemorrhages, diagnosed postmortem as Waterhouse-Friderichsen syndrome More Details, may lead to transitory adrenal insufficiency.
A Dermatological Emergency
• Meningococcaemia (meningococcal septicaemia)
– The presence of meningococci (bacteria of the
species Neisseria meningitidis) in the bloodstream.
• Communicable disease
• Affects children most commonly
• Can kill otherwise healthy children in hours.
• Purpuric rash
• +/- Oedema
• May start at any site
• Lesions are irregular in size and outline,
with a necrotic core.
Pathogenogesis of dermatological
• Septicaemia... Endotoxin- and cytokine- lead
• Microthrombi and haemorrhage in small
• Vascular Injury results in Ecchymosis
• Any febrile child with a purpuric rash should be given
systemic Antibiotics immediately and admitted
urgently to hospital.
• IM Benzyl Penicillin 1.2g at GP Surgery
• Hospital – ICU if shocked
• Acute Meningococcaemia is potentially fatal
and should be treated as a medical
• Characteristic rash needs to be promptly
recognised in order to reduce mortality.
• An example of skin manifestation of a life
threatening acute disease process.