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 ill and complained of a headache. This morning he was difficult to rouse, seemed confused, and felt warm to touch. On physical exam he is acutely ill 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 ill 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 meningococcemia present with overt signs of serious illness, approximately 5% of young febrile children with occult bacteremia are found to have meningococcal bacteremia (meningococcemia).[5] The majority of patients present with meningitis without bacteremia, or with concurrent bacteremia and central nervous system infection. Chronic meningococcemia is an uncommon syndrome characterized 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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