Diagnostic Approach to Rash and Fever in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
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
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
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.
Infections of the Central Nervous System
Keith Struthers in Clinical Microbiology, 2017
The clinical diagnosis of infection in the CNS may be straightforward. The patient with fever, headache, neck stiffness, vomiting, photophobia and the typical rash of meningococcal infection is likely to have sepsis and meningitis caused by Neisseria meningitidis. However, on many occasions the diagnosis is not straightforward. Patients present with new confusion or increased confusion, or behavioural changes considered to be compatible with a viral meningitis. On occasion the patient with a CNS infection caused by Listeria monocytogenes can present with symptoms similar to herpes encephalitis. Seizures can be the presentation of an uncommon infection, neurocysticercosis caused by the larval form of Taenia solium in the wrong host.
Prevalence of meningococcal carriage among male university students living in dormitories in Kerman, southeast of Iran
Published in Pathogens and Global Health, 2018
Mohammad Sadeghi, Roya Ahmadrajabi, Tania Dehesh, Fereshteh Saffari
Bacterial meningitis in young adults is commonly caused by Neisseria meningitidis. The incidence of meningococcal disease which appeared epidemically more frequently in developing countries is dependent on the geographical region [1,2]. Nasopharynx is the only known reservoir for this organism. Since most of the individuals with invasive meningococcal disease do not report any history for direct contact with patients, so asymptomatic carriers are considered as the most important natural sources for the development of disease [3,4]. Approximately, 5 to 30% of normal population may harbor meningococci in nasopharynx, but the rate of carriers may increase to 70 to 80% during epidemics [5]. In this study, some risk factors are found more in carriage and subsequently in infection, including male sex, cigarette smoking or passive exposure to smoke, living in closed or overcrowded communities such as dormitories, military barracks, homeless shelters, long term care facilities, prisons, etc [1,3,6].
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].
Related Knowledge Centers
- Coccus
- Meningitis
- Pharynx
- Urethritis
- Sepsis
- Gram-Negative Bacteria
- Meningococcal Disease
- Diplococcus
- Epidemic
- Sexually Transmitted Infection