Conditions · Infectious and tropical diseases
Meningococcal disease (meningococcemia) !
Meningococcal disease is a bloodstream infection or meningitis by Neisseria meningitidis that can cause a purple rash, shock and death within hours.
Updated 2026-11-01
Structures involved
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Microorganisms that cause it
In the clinical exam
Why it happens
- How septic shock develops
- Disseminated intravascular coagulation: how consumption causes both clots and bleeding
- Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does
- Shock physiology
- The coagulation cascade
- Adrenal cortex zones and medulla
What it is
Invasive infection by Neisseria meningitidis presenting as meningitis, bloodstream infection (meningococcemia) or both. Fulminant meningococcemia causes septic shock, purpura and disseminated intravascular coagulation, sometimes with adrenal haemorrhage (Waterhouse-Friderichsen syndrome).
Who gets it
Uncommon in Colombia and Latin America, with sporadic cases and occasional clusters in crowded places such as prisons, military units and schools; serogroups B, C, W and Y predominate in the region. Children, adolescents and young adults are most affected. About 1 in 10 people carry the bacterium harmlessly in the throat.
Causes
- Neisseria meningitidis, a Gram-negative diplococcus with serogroups A, B, C, W, X and Y
- Spread by respiratory droplets and throat secretions through close, prolonged contact
- Invasion from asymptomatic nasopharyngeal carriage
Risk factors
- Infants, adolescents and young adults
- Crowded living: dormitories, barracks, prisons, mass gatherings
- Terminal complement deficiency or treatment with complement inhibitors
- Asplenia or sickle cell disease
- Household contact with a case, smoking and recent viral respiratory infection
Pathophysiology
Bacteria cross the nasopharyngeal mucosa and multiply rapidly in the blood. Endotoxin (lipooligosaccharide) triggers intense inflammation, endothelial injury, capillary leak and activation of coagulation, causing microvascular thrombosis, petechiae and purpura, shock and multi-organ failure. Haemorrhage into both adrenal glands can add acute adrenal failure.
Classification
- Meningitis without shock
- Meningococcemia (septicaemia) with or without meningitis
- Fulminant meningococcemia / purpura fulminans; Waterhouse-Friderichsen syndrome
- Chronic meningococcemia (rare): recurrent fever, rash and arthritis
Symptoms and signs
- Sudden fever, chills, intense malaise and muscle or leg pain
- Petechial or purpuric rash that does not blanch with pressure, often on the trunk and limbs
- Cold hands and feet, mottled skin and delayed capillary refill
- Headache, neck stiffness, photophobia and vomiting when meningitis is present
- Confusion, drowsiness, or irritability and a bulging fontanelle in infants
Diagnosis
- Clinical
- Fever with a non-blanching rash and signs of shock or meningism is treated as meningococcal disease. Antibiotics are given immediately, before tests if necessary; lumbar puncture is postponed in shock, coagulopathy or raised intracranial pressure. The case is notified to public health at once.
- Tests
- Blood cultures and blood PCR; CSF Gram stain (Gram-negative diplococci), culture and PCR when lumbar puncture is safe. Full blood count, coagulation tests (DIC), lactate, glucose, electrolytes, kidney function and cortisol when adrenal failure is suspected. Complement testing in recurrent or unusual cases.
- Imaging
- Not needed for diagnosis; head CT before lumbar puncture when there are focal signs or reduced consciousness.
Differential diagnosis
- Sepsis from other bacteria (pneumococcus, Staphylococcus aureus, Gram-negatives)
- Dengue and other viral haemorrhagic fevers
- Rocky Mountain spotted fever (rickettsiosis)
- Immune thrombocytopenia and IgA vasculitis
- Toxic shock syndrome
Goal of treatment
Give effective antibiotics within the first hour, restore perfusion and support failing organs, and stop further cases by prophylaxis of close contacts.
Treatment
- Acute
- Immediate intravenous third-generation cephalosporin (ceftriaxone or cefotaxime); penicillin is an option once the strain is known to be susceptible.
- Acute
- Septic shock care: fluid resuscitation, vasopressors, oxygen or ventilation, correction of glucose and electrolytes and blood products for bleeding with DIC; corticosteroids in refractory shock or adrenal failure.
- Medical
- Chemoprophylaxis for close contacts (household, intimate or exposed health workers) with rifampicin, ciprofloxacin or ceftriaxone, and vaccination when the serogroup is covered.
- Follow-up
- Droplet precautions for the first 24 hours of effective therapy; intensive monitoring of blood pressure, perfusion, urine output, consciousness and skin lesions.
- Surgical
- Debridement, fasciotomy, skin grafts or amputation for necrotic skin and limbs after purpura fulminans.
Complications
- Septic shock and multi-organ failure
- Disseminated intravascular coagulation and purpura fulminans
- Waterhouse-Friderichsen syndrome (bilateral adrenal haemorrhage)
- Skin necrosis, scarring and limb amputation
- Sensorineural hearing loss and other neurological sequelae after meningitis
- Myocarditis and acute kidney injury
Prognosis
It can kill within hours even with treatment; fatality is about 10–15% overall and much higher in fulminant meningococcemia. Around 1 in 5 survivors are left with lasting effects such as amputation, hearing loss or brain damage.
Prevention
- Conjugate vaccines against serogroups A, C, W and Y, and vaccines against serogroup B, for groups at risk
- Vaccination for people with asplenia, complement deficiency or complement-inhibitor treatment
- Rapid chemoprophylaxis of close contacts
Test yourself
Think of the answer, then tap the question to see it.
What skin finding should raise suspicion of meningococcemia in a febrile patient?
A petechial or purpuric rash that does not blanch with pressure.
What is Waterhouse-Friderichsen syndrome?
Bilateral adrenal haemorrhage with acute adrenal failure during fulminant meningococcal sepsis.
Which immune defect predisposes to recurrent Neisseria infections?
Deficiency of the terminal complement components (C5–C9, membrane attack complex), or complement-inhibitor drugs.
What is the first-line empiric antibiotic class for suspected meningococcal disease?
A third-generation cephalosporin such as ceftriaxone, given immediately.
Which isolation precaution is used, and for how long?
Droplet precautions until 24 hours of effective antibiotic therapy have been completed.
Related conditions
- Bacterial meningitis
- Sepsis and septic shock
- Disseminated intravascular coagulation
- Adrenal insufficiency
- Toxic shock syndrome
Educational information, not medical advice. For any symptom, see a health professional.
Sources: About Meningococcal Disease | Meningococcal | CDC (Centers for Disease Control and Prevention, 2024); Clinical Overview of Meningococcal Disease | Meningococcal | CDC (Centers for Disease Control and Prevention, 2024); Meningitis (World Health Organization, 2025).
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