1. What is the causative agent, how does it enter the body and
how does it spread a) within the body and b) from person to
The patient has
(meningococcemia) caused by
(often termed the meningococcus). This bacterium is one of
the three principal causes of bacterial
, the other two being
serotype b (Hib).
However, the introduction of
for immunization of
infants has reduced invasive disease caused by Sp and Hib significantly.
A 19-year-old college student was in his usual state of
health until the evening before admission, when he went
to bed with a headache. He told his room-mate that he felt
feverish, and on the following morning his room-mate
found him in bed, moaning and lethargic. He was taken to
the emergency room, where he appeared toxic and
drowsy but oriented. His temperature was 40
C, his heart
100/60 mm Hg. His neck was supple. He had an impressive,
nonblanching purpuric rash, most prominent on the
trunk, wrists, and legs (Figure 1). His white blood cell count
was 26 000
with 25% band forms. The platelet count
was 80 000
. Blood cultures were obtained and the
patient was started on intravenous ceftriaxone. Blood
cultures revealed gram-negative diplococci (Figure 2).
It should be noted that in North America this patient
would have received a lumbar puncture (LP) as an essential
component in the diagnosis of meningococcal disease
except where explicitly contraindicated. However, this is
not the case in the UK where severe sepsis is a
contraindication to lumbar puncture (www.meningitis.org).
In the UK many pediatricians and adult physicians feel that
LP should not be performed acutely in patients suspected
of having meningococcal disease and, if LP is considered to
be necessary, it is done once the patient is stable. In the
case considered above the cerebrospinal fluid (CSF)
glucose, protein, and white blood cell count were normal,
and CSF bacterial culture was negative.
Legs of patient showing a purpuric rash typical
of meningococcal septicemia.
© Lydyard, Peter; Cole, Michael; Holton, John; Irving, Will; Porakishvili, Nino; Venkatesan, Pradhib; Ward, Kate, Jan 01, 201
Garland Science, Hoboken, ISBN: 9780203856871