Symptoms of meningococcal infection

Acute naesopharyngitis

Acute naesopharyngitis is the most common form of meningococcal infection, accounting for up to 80% of all cases of meningococcal infection. The disease begins acutely, usually with a fever of 37.5-38.0°C. The child complains of headache, sometimes dizziness, sore throat, pain when swallowing, and nasal congestion. Lethargy, adynamia, and pallor are noted. Examination of the pharynx reveals hyperemia and swelling of the posterior pharyngeal wall, granularity (hyperplasia of the lymphoid follicles), and swelling of the lateral folds. A small amount of mucus may be present on the posterior pharyngeal wall.

The disease often occurs with normal body temperature, satisfactory general condition, and very mild catarrhal symptoms in the nasopharynx. Moderate neutrophilic leukocytosis is sometimes noted in the peripheral blood. In half of cases, the blood count remains unchanged.

Meningococcemia

Meningococcemia (meningococcal bacteremia, meningococcal sepsis) is a clinical form of meningococcal infection, in which, in addition to the skin, various organs (joints, eyes, spleen, lungs, kidneys, adrenal glands) can be affected.

The disease begins acutely, often suddenly, with a high fever. Chills, repeated vomiting, and a severe headache, which in young children manifests as a piercing scream, may accompany this. In more severe cases, loss of consciousness is possible, and in young children, convulsions. All clinical symptoms intensify over 1-2 days. At the end of the first to beginning of the second day of illness, a hemorrhagic rash appears on the skin. It appears all over the body, but is more abundant on the legs and buttocks. The size of the rash elements ranges from pinpoint hemorrhages to large, irregular, star-shaped hemorrhages with central necrosis. In areas of extensive lesions, the necrosis subsequently sloughs off, forming defects and scars. In particularly severe cases, gangrene of the fingertips, toes, and ears is possible. In these cases, healing is slow. Hemorrhages into the sclera may occur. conjunctiva, mucous membranes of the oral cavity. Hemorrhagic rash is often combined with roseola or roseola-papular rash.

Joint damage in the form of synovitis or arthritis is possible.

Uveitis and iridocyclochoroiditis develop in the choroid. With uveitis, the choroid becomes brown (rusty) in color. The process is usually unilateral. Cases of panophthalmitis have been described. In rare cases, meningococcemia can cause pleurisy, pyelitis, thrombophlebitis, purulent liver lesions, endocarditis, myocarditis, and pericarditis. Cardiac involvement can cause shortness of breath, cyanosis, muffled heart sounds, dilated heartbeat, and other symptoms.

Renal pathology is also detected in the form of focal glomerulonephritis up to the development of renal failure, and hepatosplenic syndrome is clearly defined.

Changes in the peripheral blood during meningococcemia are manifested by high leukocytosis, a shift in neutrophils to young and myelocytes, aneosinophilia and an increase in ESR.

There are mild, moderate, and severe forms of the disease. The so-called fulminant form of meningococcemia (hyperacute meningococcal sepsis) is particularly severe.

Meningococcal meningitis

The disease begins acutely with a fever of 39-40°C (102-104°F) and severe chills. Older children complain of a severe headache, usually diffuse and without clear localization, but the pain may be particularly intense in the forehead, temples, and back of the head. Children groan, clutch their heads, become acutely restless, cry out, and experience complete sleep disruption. The headache intensifies with movement, turning the head, and strong light and sound stimuli. In some patients, agitation gives way to lethargy and indifference to the surroundings. Pain along the spine is possible, especially pronounced with pressure along the nerve trunks and roots. Any touch, even the lightest, causes severe anxiety in the patient and an increase in pain. Hyperesthesia is one of the leading symptoms of purulent meningitis.

An equally characteristic initial symptom of meningitis is vomiting. It begins on the first day and is not associated with food intake. Most patients experience repeated vomiting, sometimes multiple times, more frequently in the first days of the illness. Vomiting is the first manifest sign of incipient meningitis.

A significant symptom of meningococcal meningitis in young children is seizures. These are typically tonic-clonic and often begin within the first day of illness.

Meningeal symptoms are noted on the 2nd or 3rd day, but may be evident from the first day of illness. Most commonly, they include nuchal rigidity, Kernig's sign, and Brudzinski's sign.

Tendon reflexes are often increased, but in severe intoxication they may be absent. Clonic motion of the feet, a positive Babinski sign, and muscle hypotonia are often present. Rapidly transient cranial nerve damage (usually the third, sixth, seventh, and eighth pairs) is possible. The appearance of focal symptoms indicates cerebral edema and swelling.

Changes in the cerebrospinal fluid are of great importance for diagnosis. On the first day of illness, the fluid may still be clear or slightly opalescent, but quickly becomes cloudy and purulent due to the high neutrophil count. Pleocytosis reaches several thousand per µL. However, there are cases where pleocytosis is mild, protein levels are elevated, and sugar and chloride levels are decreased.

Meningococcal meningoencephalitis

Meningococcal meningoencephalitis occurs primarily in young children. In this form, encephalitic symptoms appear and predominate from the first days of the illness: motor agitation, impaired consciousness, seizures, and damage to the third, sixth, fifth, and eighth cranial nerves, and, less commonly, other cranial nerves. Hemi- and monoparesis are possible. Bulbar palsy, cerebellar ataxia, oculomotor disorders, and other neurological symptoms may occur. Meningeal manifestations in the meningoencephalitic form are not always clearly expressed. The disease is particularly severe and often has an unfavorable outcome.

Meningococcal meningitis and meningococcemia

Most patients experience a combined form of meningococcal infection—meningitis with meningococcemia. The clinical symptoms of mixed forms can include both meningitis and meningoencephalitis, as well as meningococcemia.