Clinical course and complications of meningococcal septicemia

Background: Meningococcal septicemia is still associated with high mortalit y with most deaths occurring within the first 24 hours. Care Report: We report on 3 patients with severe meningiococcemia. All pa t ients had an aprupt onset of clinical illness with fever and unspecific pro domilike arthralgias, myalgias and abdominal pain. On admission all patient s had severe prostration, hypotension and tachycardia. Two patients present ed purpuric rash and petechiae, meningitis was found ill only 1 patient. Gr am-negative diplococci were demonstrated in spinal fluid primarily in 2 pat ients, in all patients meningococcae could be cultured in serial blood spec imens. Because of severe cardiorespiratory distress all patients required m echanical ventilation and catecholamine:support within 24 hours of diagnosi s. Complications of meningococcemia demonstrated by these patients were coa gulopathy, meningitis, myocarditis with alterations of echocardiographic an d ECG records and elevations of CK levels and surgical relevant peripheral gangrene. Antibiotic therapy was initiated with penicillin on the day of ad mission, which resulted in stab bilisation and recuperation in all patients . Conclusions: In patients with aprupt onset of acute illness, which include fever and sudden petechial rash, severe meningococcal septicemia has to be taken in consideration without clinical signs of meningitis. The prompt dia gnosis, the use of parenteral antiobiotics in suspected meningococcal disea se as well as the;management of meningococcemia and its complications in in tensive care units is-crucial for the prognosis of the individual patient.