MeningococcemiaMihai Puia-Dumitrescu, M.D., M.P.H.

PGY1 - Pediatrics

Pediatric Emergency Medicine Rotation – May 23, 2013 Conference

Supportive care Ceftriaxone Doxycycline IVIG Clindamycin

CASE 1:You are called to examine a 6 year old boy presenting with sore throat and 12 hours history of malaise and new rash (see picture). Temp: 40C, HR: 160, RR: 32, mottled skin, with poor perfusion. What is the empiric therapy of choice for this condition?

http://see.visualdx.com/diagnosis/meningococcemia_acute.jpg

Supportive care Ceftriaxone Doxycycline IVIG Clindamycin

You are called to examine a 6 year old boy presenting with sore throat and 12 hours history of malaise and new rash (see picture). Temp 40C, HR: 160, RR: 32, mottled skin, with poor perfusion. What is the empiric therapy of choice for this condition?

http://see.visualdx.com/diagnosis/meningococcemia_acute.jpg

Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267.

Supportive care Ceftriaxone Doxycycline IVIG Clindamycin Chloramphenicol

You are called to examine a 6 year old boy presenting with sore throat and 12 hours history of malaise and new rash (see picture). Temp 40C, HR: 160, RR: 32, mottled skin, with poor perfusion. The patient is allergic to Penicillin. What is the empiric therapy of choice for this condition?

http://see.visualdx.com/diagnosis/meningococcemia_acute.jpg

Supportive care Ceftriaxone Doxycycline IVIG Clindamycin Chloramphenicol

You are called to examine a 6 year old boy presenting with sore throat and 12 hours history of malaise and new rash (see picture). Temp 40C, HR: 160, RR: 32, mottled skin, with poor perfusion. The patient is allergic to Penicillin. What is the empiric therapy of choice for this condition?

http://see.visualdx.com/diagnosis/meningococcemia_acute.jpg

Galimand M, Gerbaud G, Guibourdenche M, Riou JY, Courvalin P. High-level chloramphenicol resistance in Neisseria meningitidis. N Engl J Med. 1998;339(13):868.

Etiology: Neiserria meningitidis

Clinical Presentation: Prodrome:

URI symptoms, pharyngitis, fever Lethargy, headache, vomiting Myalgias, arthralgias

Septicemia: Abrupt worsening of prodromal symptoms Rash: Tender pink macules, petechiae (75%), purpurafrank necrosis Shock: Mottling, poor perfusion, +/- hypotension DIC

Meningitis

Treatment: 3rd generation cephalosporin – follow cultures and sensitivities Supportive care: Fluid replacement, pressors as needed

Meningococcemia

One more…

The rash is the classic symptom but is not specific

Fever, throat pain, and mottling of the skin

Leg pain, cold hands and feet, and abnormal skin color

Petechial rash, fever and headache Cold extremities, neck stiffness,

abdominal pain

CASE 2: After participating in the stabilization of a 12 year old patient with meningococcemia, your student is asking which are the first specific signs and symptoms suggesting early sepsis in a patient with meningococcal disease. Your answer will be:

http://see.visualdx.com/diagnosis/meningococcemia_acute.jpg

The rash is the classic symptom but is not specific

Fever, throat pain, and mottling of the skin

Leg pain, cold hands and feet, and abnormal skin color

Petechial rash, fever and headache Cold extremities, neck stiffness,

abdominal pain

After participating in the stabilization of a 12 year old patient with meningococcemia, your student is asking which are the signs and symptoms suggesting early sepsis in a patient with meningococcal disease. Your answer will be:

http://see.visualdx.com/diagnosis/meningococcemia_acute.jpg

Worrisome signs — Although initial clinical features of patients with meningococcal disease are similar to many common, self-limiting viral illnesses seen in primary care, signs of early sepsis should differentiate the patient who merits clinical monitoring. Based on the retrospective review of 448 children with meningococcal disease cited below, signs and symptoms suggesting early sepsis include: Leg pain Cold hands and feet Abnormal skin color (eg, pallor or mottling)

Meningococcemia

Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267.

http://www.uptodate.com/contents/treatment-and-prevention-of-meningococcal-infection?source=search_result&search=meningococcemia+treatment&selectedTitle=1%7E43#H5

Thank You!