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Bilateral adrenal destruction
68%
156/231
Pelvic inflammatory disease
13%
29/231
Septic arthritis
11%
26/231
Osteomyelitis
4%
10/231
Acute endocarditis
3%
7/231
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The patient has symptoms of meningococcemia, a form of sepsis due to intravascular multiplication of Neisseria meningitidis. Meningococcemia may progress to fulminant meningococcemia with bilateral hemorrhage into and destruction of the adrenal glands, a condition known as Waterhouse-Friederichsen syndrome. In Waterhouse-Friederichsen syndrome patients experience abrupt onset of hypotension and tachycardia. Disseminated intravascular coagulation (DIC) and coma may ensue. Death may occur within 6-8 hours. N. meningitidis is a Gram-negative diplococcus that most commonly causes meningitis, especially in infants. It can be differentiated from N. gonorrhoeae through its ability to metabolize maltose. Penicillin G or ceftriaxone should be given immediately if disseminated meningococcemia is suspected. Kimmel reviews important measures to prevent meningococcal infections. He recommends antibiotic chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone for household and other close-contacts. Additionally, the meningococcal vaccine should be given to 11- and 12-year-olds, individuals entering high school, and college freshmen living in dormitory settings. Brandtzaeg et al. review fulminant meningococcemia. They find that the clinical presentation centers around septic shock, with treatment including IV fluids, vasoactive medications, artificial ventilation (due to development of acute respiratory distress syndrome - ARDS). Additional features of the disease presentation include kidney failure, hemorrhagic skin lesions, and adrenal hemorrhage. Illustration A depicts N. meningitidis; note the Gram-negative diplococci. Illustration B shows a gross image of the bilateral adrenal hemorrhage that occurs in Waterhouse-Friederichsen syndrome. Incorrect answers: Answer 2: Pelvic inflammatory disease (PID) is typically a complication of Neisseria gonorrhoeae. Answer 3: Septic arthritis is typically a complication of Neisseria gonorrhoeae. Answer 4: Several organisms may cause osteomyelitis, including Pseudomonas aeruginosa and Staphylococcus aureus. Osteomyelitis is not a common complication of meningococcemia. Answer 5: S. aureus is the agent most commonly responsible for acute endocarditis.
4.7
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