Teaching Pearls: 

Four Clinical Manifestations of Meningococcal Disease (Mandells page 2321):

1. Bacteremia without Sepsis: Present with upper respiratory illness or viral exanthem. Often recover without specific antibiotic therapy, and then blood cultures result positive for N. Meningitidis.
2. Meningococcemia without meningitis: In these cases, patients are septic and often have skin rash, malaise, weakness, headache, and hypotension.
3. Meningitis with or without meningococcemia: In these patients, headache, fever, and meningeal signs are present with a cloudy spinal fluid.
4. Meningoencephalitic Manifestation: These patients are profoundly obtunded with meningeal signs and septic spinal fluid. Deep tendon reflexes are altered.

Meningococcal disease is carried in the nasopharynx of otherwise healthy people. It is spread via aerosolized secretions

Risk factors for disease include smoking, recent URIs, crowded places (dorms, military recruits, complement deficiency)

Treatment is with 3rd generation cephalosporins. Prophylaxis for close contacts usually consists of a single dose of ciprofloxacin.

The initial rash of Meningococcemia/meningitis can appear maculopapular resembling a viral exanthem.

The typical initial presentation is acute onset of fever, N/V, headache, decreased ability to concentrate, and severe myalgias

Major complications of meningococcemia include DIC, purpural fulminans, adrenal hemorrhage.