PEDIATRICS Vol. 72 No. 4 October 1983, pp. 469-472
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jacobs, R. F.
Right arrow Articles by Morrow, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jacobs, R. F.
Right arrow Articles by Morrow, R.

Apparent Meningococcemia: Clinical Features of Disease Due to Haemophilus influenzae and Neisseria meningitidis

Richard F. Jacobs MD1, Steven Hsi BS1, Christopher B. Wilson MD1, Denis Benjamin MB, BCh1, Arnold L. Smith MD1, and Robert Morrow MD1

1 From the Division of Infectious Disease, Departments of Pediatrics and Pathology, Children's Orthopedic Hospital and Medical Center, and University of Washington School of Medicine, Seattle

To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed. A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae. Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant. All patients were febrile (>38°C) and appeared toxic. Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission. Ten of 12 patients with H influenzae infection compared with 15/30 (P < .05) with meningococcal infection were lethargic or comatose at the time of admission. Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P < .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 ± 11.4 [SE] hours) was significantly shorter (P < .05) than with meningococcal infection (120 ± 74.4 hours). Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents. Initial antibiotic therapy should be directed against these pathogens.

Key Words: Waterhouse-Friderichsen syndrome • meningococcus • Haemophilus influenzae

Accepted on January 6, 1983




This article has been cited by other articles:


Home page
 NEJMHome page
P. V. Adem, C. P. Montgomery, A. N. Husain, T. K. Koogler, V. Arangelovich, M. Humilier, S. Boyle-Vavra, and R. S. Daum
Staphylococcus aureus Sepsis and the Waterhouse-Friderichsen Syndrome in Children
N. Engl. J. Med., September 22, 2005; 353(12): 1245 - 1251.
[Abstract] [Full Text] [PDF]

Home page
 Journal of Pharmacy PracticeHome page
R. A. Zabinski, K. Vance-Bryan, and J. C. Rotschafer
The Management of Central Nervous System Infections
Journal of Pharmacy Practice, January 1, 1991; 4(3): 170 - 191.
[PDF]