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Clinical, histopathologic & immunologic features of cutaneous lesions in acute meningococcaemia
V Ramesh1, A Mukherjee, M Chandra
1Department of Dermatology, Safdarjang Hospital, New Delhi.
Abstract:
Fifty children with culture proven acute meningococcaemia were studied during the winter outbreak of the disease in 1986-87. Purpuric lesions were seen in 60 per cent, erythematous papules in 32 per cent, faint pink macules in 28 per cent, conjunctival petechiae in 10 per cent and herpes labialis in 20 per cent. Histopathology of skin lesions showed that the primary damage was to the dermal vessels, the extent of damage depending on the type of skin involvement. Diplococci in Gram's stained sections were seen frequently in purpuric as compared to the other skin lesions. They were located in degenerating neutrophils, endothelial cells, fibrin clots or freely in the vascular lumen. Electron microscopic study showed vascular changes accompanied by a perivascular phagocytic response. Both light and electronmicroscopy indicated the involvement of the coagulative mechanism in the pathogenesis of meningococcaemia. However, clinical parameters of clotting were often within normal limits. In the case of a child (who died eventually), a low platelet count and prolonged coagulation indices were observed. Sera from some of the children were tested for the presence of antibodies against meningococci by indirect immunofluorescence. Antibodies were detected in the sera and they may have a role in regulating the severity and course of the illness. The significance of immunoglobulin deposits in the skin lesions is not clear.
Insights
This study investigated acute meningococcaemia in children, finding dermal vessel damage and diplococci in skin lesions. Antibodies against meningococci were detected, potentially influencing disease severity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Acute meningococcaemia is a serious bacterial infection, particularly in children.
- Skin manifestations are common but varied, requiring detailed histopathological analysis.
- Understanding the pathogenesis is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To characterize the skin lesions in children with acute meningococcaemia.
- To investigate the role of Neisseria meningitidis in dermal pathology.
- To explore the potential role of antibodies in disease course.
Main Methods:
- Histopathological examination of skin biopsies from 50 children.
- Gram staining and electron microscopy of tissue samples.
- Serological testing for meningococcal antibodies using indirect immunofluorescence.
Main Results:
- Purpuric lesions were most common (60%), with histopathology revealing primary damage to dermal vessels.
- Diplococci were frequently observed in purpuric lesions, located within various cellular and extracellular components.
- Electron microscopy indicated vascular damage and a phagocytic response, suggesting coagulative mechanism involvement.
- Antibodies against meningococci were detected in sera, correlating with disease severity.
Conclusions:
- Skin lesions in meningococcaemia primarily involve dermal vessel damage, with bacterial presence varying by lesion type.
- Coagulative pathway activation is implicated in pathogenesis, though clinical signs may be absent.
- Meningococcal antibodies may modulate disease severity and progression.