Meningococcemia Differential Diagnoses

Updated: Sep 15, 2021
  • Author: Mahmud H Javid, MBBS; Chief Editor: John L Brusch, MD, FACP  more...
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Diagnostic Considerations

The cutaneous differential diagnosis of acute meningococcemia encompasses multiple entities, including other infectious processes such as leptospirosis, Rocky Mountain spotted fever, and acute viral syndrome. Other differential diagnoses for acute meningococcemia include acute hypersensitivity vasculitides, septic vasculitis due to acute bacteremia or endocarditis, toxic shock syndrome, and purpura fulminans.

Chronic meningococcemia may resemble chronic gonococcemia, Henoch-Schönlein purpura, rat-bite fever, Sweet syndrome, erythema multiforme, and subacute bacterial endocarditis.

Importantly, glucocorticoids administered for the rash and arthritis of rheumatic diseases would substantially worsen the course of meningococcemia.

Other causes of purpura or petechiae

Only 2-11% of children with petechiae and fever have invasive meningococcal disease. Although most other children probably have viral infections, antibiotic therapy should be commenced without awaiting additional information. Distinguishing meningococcal disease from other causes in these cases is difficult, and the fatality rate is high. Other causes may include the following:

  • Bacterial infections - Pneumococcal septicemia, group A streptococcal septicemia, other gram-positive or gram-negative sepsis, and syphilis

  • Viral infections - Epstein-Barr virus infection, enterovirus infection, measles, rubella, herpes simplex virus infection, cytomegalovirus infection, hemorrhagic viral fevers (eg, dengue)

  • Other infections - Mycoplasma infection (usually maculopapular), Rocky Mountain spotted fever, epidemic typhus, ehrlichiosis, leptospirosis, and Candida infection

  • Platelet disorders - Immune thrombocytopenia, leukemia, other causes of bone marrow failure, Bernard-Soulier disease, and Glanzmann disease

  • Clotting disorders - Hemophilia, von Willebrand disease, vitamin K deficiency, and congenital or acquired protein C or S deficiency

  • Autoantibody-mediated causes - Often after varicella, group A hemolytic cause, Streptococcus or other viral (eg, rubella) infections, coumarin drugs, cholestasis, renal dialysis, nephrotic syndrome, and bone marrow transplantation

  • Vasculitis - Henoch-Schönlein purpura, polyarteritis, antiphospholipid syndrome, other vasculitides, and Kawasaki disease,

  • Trauma - Injury and violent coughing or emesis

  • Connective tissue disease - Osteogenesis imperfecta, Marfan syndrome, and vitamin C deficiency

  • Miscellaneous - Cushing syndrome, hemolytic uremic syndrome, drug ingestion, erythema nodosum, erythema multiforme, and spider and snake bites

Other differentials

Other conditions to consider in the differential diagnosis of meningococcal infection include the following:

  • Enteroviruses

  • Infective endocarditis

  • Influenza

  • Leptospirosis

  • Malaria

  • Antiphospholipid antibody syndrome

  • Bernard-Soulier syndrome

  • Bone marrow transplantation

  • Cholestasis

  • Enterococcal infection

  • Hemophilia A, B, and C

  • Kawasaki disease

  • Marfan syndrome

  • Nephrotic syndrome

  • Osteogenesis imperfecta

  • Polyarteritis nodosa

  • Bacterial sepsis - Gonococcemia, Haemophilus influenzae infection, and Streptococcus pneumoniae infection

  • Anaphylactoid purpura

  • Arboviral infections

  • Capnocytophaga canimorsus (dysgonic fermenter-2 [DF-2]) infection

  • Marburg virus infection

  • Acute febrile neutrophilic dermatosis (Sweet syndrome)

  • H influenzae meningitis - The H influenzae type B vaccine caused the decline of meningitis related to this bacteria; half of all childhood cases of bacterial meningitis are caused by N meningitidis, and most other cases are pneumococcal

Differential Diagnoses