TAILIEUCHUNG - Chapter 136. Meningococcal Infections (Part 6)

Clinical Manifestations Upper Respiratory Tract Infections Although many patients who develop meningococcal meningitis or meningococcemia report having had throat soreness or other upper respiratory symptoms during the preceding week, it is uncertain whether these symptoms are due to infection with meningococci. Meningococcal pharyngitis is rarely diagnosed. Adult patients with N. meningitidis bacteremia more often have clinically apparent disease of the respiratory tract (pneumonia, sinusitis, tracheobronchitis, conjunctivitis) than do younger patients. Meningococcemia Patients with meningococcal disease may have both meningococcemia and meningitis. These conditions have a wide clinical spectrum, with many overlapping features. Approximately 10–30% of patients with meningococcal disease have meningococcemia without clinically. | Chapter 136. Meningococcal Infections Part 6 Clinical Manifestations Upper Respiratory Tract Infections Although many patients who develop meningococcal meningitis or meningococcemia report having had throat soreness or other upper respiratory symptoms during the preceding week it is uncertain whether these symptoms are due to infection with meningococci. Meningococcal pharyngitis is rarely diagnosed. Adult patients with N. meningitidis bacteremia more often have clinically apparent disease of the respiratory tract pneumonia sinusitis tracheobronchitis conjunctivitis than do younger patients. Meningococcemia Patients with meningococcal disease may have both meningococcemia and meningitis. These conditions have a wide clinical spectrum with many overlapping features. Approximately 10-30 of patients with meningococcal disease have meningococcemia without clinically apparent meningitis. Although meningococcal bacteremia may occasionally be transient and asymptomatic in most individuals it is associated with fever chills nausea vomiting and myalgias. Prostration is common. The most distinctive feature is rash. Erythematous macules rapidly become petechial and in severe cases purpuric see Fig. 52-5 . Although the lesions are typically found on the trunk and lower extremities they may also occur on the face arms and mucous membranes. The petechiae may coalesce into hemorrhagic bullae or may undergo necrosis and ulcerate. Patients with severe coagulopathy may develop ischemic extremities or digits often with a sharp line of demarcation between normal and ischemic tissue. In many patients with fulminant meningococcemia the CSF may be normal and the CSF culture negative. Indeed the absence of meningitis in a patient with meningococcemia is a poor prognostic sign it suggests that the bacteria have multiplied so rapidly in the blood that meningeal seeding has not yet occurred or had time to elicit inflammation in the CSF. Most of these patients also lack evidence of an .

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