CURRENT Essentials of Critical Care.pdf

266 Current Essentials of Critical Care■■■MeningococcemiaEssentials of Diagnosis• Neisseria meningitidis: gram-negative diplococcus causingspectrum of diseases, most commonly in children under age 15• Incubation period 2–10 days; insidious or abrupt onset• Petechial rash on trunk, lower extremities, palms, soles and mucousmembranes; rash may be urticarial or morbilliform• May be complicated by purpura fulminans, with extensive hemorrhagicbullae and areas of necrosis• Other complications include meningitis, arthritis, myocarditis,pericarditis, acute adrenal infarction, hypotension, shock• Diagnosis confirmed by demonstrating organism by Gram stainor culture (blood, cerebrospinal fluid (CSF), skin lesion) or byserologic testingDifferential Diagnosis• Sepsis or meningitis caused by other bacteria• Rocky Mountain spotted fever• Viral infections (echovirus, coxsackievirus, atypical measles)• VasculitisTreatment• Supportive care with attention to maintaining blood pressure andorgan perfusion• Intravenous penicillin or ceftriaxone■ PearlRespiratory isolation is mandatory for suspected meningococcal disease;consider ciprofloxacin or rifampin for close contacts of patientswith intimate exposure.ReferenceStephens DS, Zimmer SM: Pathogenesis, therapy, and prevention of meningococcalsepsis. Curr Infect Dis Rep 2002;4:377. [PMID: 12228024]