Dermatology - Meningococcemia
Neisseria meningitides establishes itself in the human nasopharynx and is transmitted from one person to another through respiratory droplets. The symptoms of meningococcal meningitis are characteristic of bacterial meningitis, including fever, headache, neck stiffness, and the presence of polymorphonuclear leukocytes (PMNs) in the cerebrospinal fluid. Abnormalities Shortly after the condition begins, there are small, pink spots and raised areas on the skin that can turn white when pressed. Petechiae and ecchymoses are observed on the ankles, wrists, axillae, mucosal surfaces, and conjunctivae due to vascular fragility and bleeding. Petechiae may form in clusters at areas of pressure, whereas ecchymoses and purpura might develop into hemorrhagic bullae, experience necrosis, and eventually ulcerate. Purpura fulminans, in extreme instances, manifests as irregularly shaped, merging necrotic hemorrhagic lesions that appear grayish to black. Fulminant disease may exhibit disseminated intravascular coagulation. Patients may develop sepsis, a potentially life-threatening condition characterized by a systemic infection. Additionally, they may experience peripheral gangrene, a condition where tissue in the extremities dies due to reduced blood flow. Waterhouse-Friderichsen syndrome is an acute and severe form of meningococcal septicemia. It is marked by symptoms such as high fever, shock, extensive purpura (purple discoloration of the skin), disseminated intravascular coagulation (abnormal blood clotting throughout the body), thrombocytopenia (low platelet count), and adrenal insufficiency (inadequate functioning of the adrenal glands). A conclusive diagnosis necessitates the isolation of meningococci from either the bloodstream or the specific location of illness. The differential diagnosis encompasses adverse cutaneous drug eruptions, vasculitis, Rocky Mountain spotted fever, and infective endocarditis. Administer third-generation cephalosporins (ceftriaxone or cefotaxime) as the initial treatment. If the strain is susceptible, possible alternatives include penicillin G, ampicillin, fluoroquinolone, or aztreonam. The typical period of therapy is 7 days. For people with a strong allergy to penicillin, it is recommended to administer chloramphenicol (1 g IV every 6 hours) instead of taking the risk of experiencing cross-reactions with a third-generation cephalosporin. Administer supportive care measures to safeguard the functionality of affected organs.
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