Outline the diagnostic features, complications and treatment of patients with meningococcal sepsis.
• Acute systemic meningococcal disease is usually manifest as meningitis &/or meningococcaemia. The diagnostic features include: history of sudden onset of fever/nausea/vomiting/headache/myalgias (sometimes intense), with rapid progression. Examination may reveal hypotension, tachycardia, diaphoresis, and discrete petechiae (initially 1-2 mm diameter; may coalesce). Shock is often profound with extreme vasoconstriction. Blood cultures and CSF cultures are often positive.
• Complications include refractory shock, disseminated intravascular coagulation (including bleeding and major vessel thrombosis), cerebral oedema, and myocardial dysfunction.
• Treatment is with immediate antibiotics. High dose penicillin (2 million units every 2 hours for adults) or chloramphenicol or 2nd or 3rd generation cephalosporins (according to sensitivities). Supportive care for shock (vasopressors and fluids) and other complications (eg. DIC, ARDS etc). Other unproven therapies may include plasmapheresis or activated protein C.
A good NEJM review article is available which covers this territory well.
Diagnostic features of meningococcal sepsis
Complications of meningococcal sepsis
Management of meningococcal sepsis
Rosenstein, Nancy E., et al. "Meningococcal disease." New England Journal of Medicine 344.18 (2001): 1378-1388.
Mautner, L. S., and W. Prokopec. "Waterhouse-Friderichsen Syndrome."Canadian Medical Association journal 69.2 (1953): 156.
Kumar, Ajay, et al. "Plasma exchange and haemodiafiltration in fulminant meningococcal sepsis." Nephrology Dialysis Transplantation 13.2 (1998): 484-487.