Case history
Case history #1
A 20-year-old college student presents to the emergency department with fever and confusion. The previous night he felt unwell and had complained of a headache. This morning he was difficult to arouse, seemed confused, and felt warm to touch. On physical examination he is acutely unwell with fever, tachycardia, and mild hypotension. He opens his eyes and withdraws in response to painful stimuli. Nuchal rigidity and a few truncal petechiae are present.
Case history #2
A 9-month-old girl is brought to the emergency department with a history of fever and a rash. She was in good health until this morning, when she developed a fever, irritability, and poor feeding. In the afternoon her parents noticed purple bruises on her legs and trunk. On examination she is alert but appears acutely unwell with fever, tachycardia, cool extremities, delayed capillary refill time of 5 seconds, and multiple ecchymoses on her legs and trunk.
Other presentations
Occasionally Neisseria meningitidis causes focal infections such as pneumonia, conjunctivitis, pericarditis, myocarditis, septic arthritis, endophthalmitis, peritonitis, and salpingitis.[4] Although most patients with meningococcaemia present with overt signs of serious illness, approximately 5% of young febrile children with occult bacteraemia are found to have meningococcal bacteraemia (meningococcaemia).[5] The majority of patients present with meningitis without bacteraemia, or with concurrent bacteraemia and central nervous system infection; a minority present with bacteraemia alone. Chronic meningococcaemia is an uncommon syndrome characterised by several weeks to months of recurrent or continuous fever, headache, migratory arthritis or arthralgia, and a maculopapular or petechial rash.[6]
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