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[Therapy-refractory fulminant meningococcal sepsis]
A Eigentler1, P Lechleitner, C Wiedermann
1Bundesstaatliche bakteriologisch-serologische Untersuchungsanstalt, Universität Innsbruck.
Insights
Severe meningococcal infection can rapidly cause life-threatening consumptive coagulopathy and shock. Early recognition of Neisseria meningitidis is crucial, even without meningitis symptoms.
Area of Science:
- Infectious Diseases
- Hematology
Background:
- Meningococcal infection, caused by Neisseria meningitidis, is a serious bacterial illness.
- Severe forms can lead to rapid deterioration and complications such as coagulopathy.
Observation:
- Two pediatric cases presented with sudden fever, petechiae, and rapid progression.
- Neither patient exhibited clinical signs of meningitis, complicating early diagnosis.
Findings:
- Both patients developed severe consumptive coagulopathy, characterized by abnormal prothrombin, PTT, fibrinogen, and platelet counts.
- One patient experienced treatment-resistant shock, while the other developed profound anemia, leading to fatal outcomes in both.
- Neisseria meningitidis was isolated from blood cultures, confirming meningococcal sepsis.
Implications:
- Highlights the critical need for prompt diagnosis and management of meningococcal sepsis, particularly in cases presenting without typical meningitis signs.
- Underscores the potential for rapid progression to consumptive coagulopathy and shock, necessitating aggressive supportive care.
- Emphasizes the importance of blood cultures for identifying Neisseria meningitidis in severe febrile illnesses with petechial rash.
Abstract:
Two cases of the severe form of meningococcal infection are described. A 17-year-old girl and a (unrelated) 2-year-old boy suddenly developed fever and rigor. Several hours later petechiae of the skin were noted: they rapidly spread. On admission the girl was found to have a severe consumptive coagulopathy (prothrombin 24%, partial thromboplastin time 104 sec, fibrinogen 73 mg/dl, platelets 35,000/microliters). She died two-and-a-half hours after admission of treatment-resistant shock. The boy had at first only a low prothrombin value (39%), but later the other coagulation values also became abnormal. He died 16 hours after admission from the consumptive coagulopathy and profound anaemia (haemoglobin 7.4 g/dl, haematocrit 0.23). Neither patient had any clinical signs of meningitis. Isolation of Neisseria meningitidis from blood cultures confirmed the diagnosis.