title: [Clinical course and complications of meningococcal septicemia].
abstract: BACKGROUND
  Meningococcal septicemia is still associated with high mortality with most deaths occurring within the first 24 hours.
  
  
  METHODS
  We report on 3 patients with severe meningiococcemia. All patients had an aprupt onset of clinical illness with fever and unspecific prodomi like arthralgias, myalgias and abdominal pain. On admission all patients had severe prostration, hypotension and tachycardia. Two patients presented purpuric rash and petechiae, meningitis was found in only 1 patient. Gram-negative diplococci were demonstrated in spinal fluid primarily in 2 patients, in all patients meningococcae could be cultured in serial blood specimens. Because of severe cardiorespiratory distress all patients required mechanical ventilation and catecholamine support within 24 hours of diagnosis. Complications of meningococcemia demonstrated by these patients were coagulopathy, meningitis, myocarditis with alterations of echocardiographic and ECG records and elevations of CK levels and surgical relevant peripheral gangrene. Antibiotic therapy was initiated with penicillin on the day of admission, which resulted in stabilisation 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 diagnosis, the use of parenteral antiobiotics in suspected meningococcal disease as well as the management of meningococcemia and its complications in intensive care units is crucial for the prognosis of the individual patient.
authors.affiliation: Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf. heintzen@uni-duesseldorf.de
authors.forename: F
authors.initials: F
authors.lastname: Gradaus
authors.forename: R M
authors.initials: RM
authors.lastname: Klein
authors.forename: H J
authors.initials: HJ
authors.lastname: von Giesen
authors.forename: G
authors.initials: G
authors.lastname: Arendt
authors.forename: M P
authors.initials: MP
authors.lastname: Heintzen
authors.forename: M
authors.initials: M
authors.lastname: Leschke
authors.forename: B E
authors.initials: BE
authors.lastname: Strauer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology*; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D016920:Meningitis, Bacterial / Q000382:microbiology; D008589:Meningococcal Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D009205:Myocarditis / Q000382:microbiology; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
vernacular_title: Klinischer Verlauf und Komplikationen der Meningokokkensepsis.