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Dermatological Emergency: Meningococcal Disease

Meningococcal disease is an illness caused by the bacteria Neisseria meningitidis. The two common presentations of meningococcal infection are meningococcal meningitis (infection of the membranes that surround the brain and spinal cord) and meningococcemia (infection of the bloodstream). An infected individual may suffer one or both of these diseases.

Petechiae due to meningococcal disease 

 

It should be considered when there is:

• Neck stiffness

• Headache

• Nausea and vomiting

• Neck and/or back pain

• Fever and chills

• Increased sensitivity to light

• Irritability or confusion

• Petechiae (rash of small red or purple spots [purpura] that do not disappear when pressure is applied to the skin)

• A blanching or maculopapular rash

• A rash that progresses to larger red patches or purple lesions (similar to bruises)

• Rapid clinical deterioration.

Infants may present differently with symptoms such as refusing feeds, increased irritability, excessive sleepiness, fever, a bulging fontanelle (soft spot on the head), inconsolable crying, or seizures.

Key Points:

• Petechiae occur in 50–75% of cases of meningococcaemia.

• The rash is most often found on the trunk and extremities but may progress to involve any part of the body.

• Not all patients have skin signs.

• Patients may initially just have a rash and not be particularly unwell.

• Early recognition of meningococcal infection is critical as meningococcemia spreads so quickly that within hours of symptoms appearing, a patient may rapidly die.

• Patients with either meningococcemia or meningococcal meningitis must be hospitalised and treated with antibiotics and supportive care immediately.

Why it matters:

Meningococcal disease is a medical emergency and patients showing signs and symptoms suspicious of meningococcal infection need to seek medical advice from their doctor or a hospital immediately. A delay of even hours can be fatal.

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