N.Menegitides

Question 1

A 19-year-old college student was in his usual state of health until the evening before admission, when he went to bed with a headache. He felt feverish, and on the following morning his mother found him in bed, moaning and lethargic. He was taken to the emergency room, where he appeared toxic and drowsy but oriented. His temperature was 40°C, his heart rate was 126/min, and his blood pressure was 100/60 mm Hg. His neck was supple. He had an impressive, non-blanching purpuric rash, most prominent on the trunk, wrists, and legs.

Answer 1

a) What is the causative organism of this infection?
meningococcemia, which can occur with or without meningitis.
a) Causative organism:
Neisseria meningitidis.a gram-negative diplococcus.
ليه؟
The presence of non-blanching purpuric rash, just few hours fever, and signs of toxicity in a young adult are classic for invasive meningococcal infection.

Question 2

طب ليه مش Measels

Answer 2

1-Non bleanching pruritic rash
لكن مع measelesبيبقي blanching
2-rash appear within hours of fever
لكن في measels بيبان بعد الحرارة ب٣-٥ أيام
3- typical prodroma of measels
Is cough, coryza, conjunctivitis, Koplik spots
خلي بالك بقي ممكن الmeningococcemia تيجي ب
Sapple neck زي ماهو مكتوب كده

Question 3

Diagnosis

Answer 3

Clinical suspicion:

Sudden high fever, headache, lethargy, toxic appearance.

Non-blanching purpuric rash is a classic sign of meningococcemia.

2. Laboratory Tests:

Blood cultures: Often positive early.

Lumbar puncture (CSF analysis) (if not contraindicated):

Elevated opening pressure

High WBC count (neutrophilic), low glucose, high protein

Gram stain may show gram-negative diplococci.

PCR for N. meningitidis in blood or CSF (especially if antibiotics were given early).

CBC: May show leukocytosis or leukopenia, thrombocytopenia.

Coagulation studies: DIC is common.

Question 4

Treatment

Answer 4

1. Immediate empiric antibiotics:

IV Ceftriaxone or Cefotaxime

Add Vancomycin initially (until resistant strains are ruled out).

Penicillin G may be used if the strain is known to be sensitive.

2. Supportive care:

IV fluids, vasopressors if hypotensive

ICU monitoring

Manage potential complications: DIC, shock, adrenal insufficiency (Waterhouse-Friderichsen syndrome)

3. Prophylaxis for close contacts:

Rifampin, Ciprofloxacin, or Ceftriaxone