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Diagnostic Approach to Rash and Fever in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Lee S. Engel, Charles V. Sanders, Fred A. Lopez
Meningococcemia can occur sporadically or in epidemics and is more commonly diagnosed during the winter months. Neisseria meningitidis is primarily spread by respiratory droplets that require close, prolonged contact for transmission [15]. The risk of infection is highest in infants, asplenic patients, alcoholics, patients with complement deficiency, and persons who live in dormitories (coeds, military personnel, or prisoners). Initial symptoms include cough, headache, sore throat, nausea, and vomiting. Acute meningococcemia progresses rapidly, and patients typically appear ill, with high spiking fevers, tachypnea, tachycardia, mild hypotension, and a characteristic petechial rash [16,17]. Signs and symptoms of meningeal irritation such as headache, vomiting, and change in consciousness occur in up to 88% of patients with meningococcemia [16,18].
Vasculitis mimics
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Debdeep Mitra, Ajay Chopra, Neerja Saraswat
Important bacterial species causing vasculitis mimics and their mechanisms include the following: Direct invasion by the bacteria leading to the formation of mycotic aneurysms are seen in staphylococcus, streptococcus, and salmonella infections.Tropism for vascular endothelium is a feature of rickettsial species (Figure 33.1). This results in widespread leak from the microvasculature, formation of thrombi in the region, eventually leading to widespread organ involvement.Neisseria species is associated with small vessel vasculitis. This is the reason for pustule formation seen in Neisseria gonorrhea infection. Neisseria meningitidis can also result in skin and gastrointestinal tract endothelium damage showing necrosis and thrombosis.
Meningococcemia rash
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Neisseria meningitidis is a common cause of community-acquired bacterial meningitis in children and adults. Neisseria meningitidis is carried in the nasal passages and is spread through inhalation of aerosolized particles, making living in close quarters (such as college dormitories) an ideal environment for disease spread. Neisseria meningitidis can produce a range of clinical symptoms, from fever and bacteremia to fulminant disease with death possible within hours of onset.
An update on biologic treatments for neuromyelitis optica spectrum disorder
Published in Expert Review of Clinical Immunology, 2023
Eculizumab (Soliris®) was approved by the US FDA in 2019 as a treatment for adult AQP4-IgG seropositive NMOSD. As stated in a boxed warning, eculizumab increases the risk of meningococcal and encapsulated bacterial infection by blocking the terminal complement system [62]. In the PREVENT trial, patients were vaccinated against Neisseria meningitidis before receiving the study drug, and no N. meningitidis infections were reported. During the open-label extension study, one patient administered eculizumab plus azathioprine died of pulmonary empyema. The rate of serious infections was lower with eculizumab monotherapy than placebo during PREVENT and its open-label extension study [58,60]. The advantages of eculizumab include preservation of immunosurveillance, immediate onset of action, and persistent efficacy; however, the need for frequent IV administration and high cost are important drawbacks [63].
4CMenB vaccine and its role in preventing transmission and inducing herd immunity
Published in Expert Review of Vaccines, 2022
Mark McMillan, Helen S Marshall, Peter Richmond
Neisseria meningitidis is a commensal bacteria of the pharynx in humans. Adolescents and young adults have the highest carriage prevalence in many parts of the world [1]. Humans are the only hosts for N. meningitidis bacteria, with transmission from person to person occurring through respiratory droplets or saliva exchange [2]. The vast majority of people who acquire N. meningitidis pharyngeal carriage remain asymptomatic, and carriage can last weeks, months, a year, or more [3–6]. In high-income countries, where the prevalence of meningococcal B disease is highest, asymptomatic carriage gradually increases through childhood and peaks in adolescents and young adults, then wanes through adulthood [1]. Thus, adolescents and young adults are the key groups when considering effective herd immunity strategies for meningococcal disease.
Heterogeneity in myasthenia gravis: considerations for disease management
Published in Expert Review of Clinical Immunology, 2021
Amelia Evoli, Gregorio Spagni, Gabriele Monte, Valentina Damato
In patients with refractory AChR-MG, the REGAIN trial showed that eculizumab, in association with standard-of-care treatment, was well tolerated and more effective than placebo (the trial did not meet the primary efficacy endpoint, while was successful in nearly all secondary outcomes) [132]. Clinical benefit continued through the open-label extension phase [133,134]. New complement-inhibitors, ravulizumab (NCT03920293) and zilucoplan (NCT04115293), are currently evaluated in phase 3 RCTs in patients with generalized, not necessarily refractory, disease. The indication for complement inhibitors does not include MuSK-MG (Figure 3) (pathogenic Abs are mostly IgG4) while can include LRP4 Ab-positive cases. Before treatment, patients must be vaccinated for neisseria meningitidis. Infections, though generally mild, are the most common AEs [131].