1. Meningococcemia Mihai Puia-Dumitrescu, M.D., M.P.H. PGY1 - Pediatrics
Pediatric Emergency Medicine Rotation – May 23, 2013 Conference

2. 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?
Supportive care
Ceftriaxone
Doxycycline
IVIG
Clindamycin

3. 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?
Supportive care
Ceftriaxone
Doxycycline
IVIG
Clindamycin
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.

4. 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?
Supportive care
Ceftriaxone
Doxycycline
IVIG
Clindamycin
Chloramphenicol

5. 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?
Supportive care
Ceftriaxone
Doxycycline
IVIG
Clindamycin
Chloramphenicol
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.

6. Meningococcemia 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%), purpurafrank necrosis
Shock: Mottling, poor perfusion, +/- hypotension
DIC
Meningitis
Treatment:
3rd generation cephalosporin – follow cultures and sensitivities
Supportive care: Fluid replacement, pressors as needed

7. One more…

8. 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:
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

9. 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:
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

10. Meningococcemia
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)
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.

11. Thank You!