Advertisement

Spotted Fever: Meningococcal Disease and Petechiae

      Although there are descriptions of skin findings and invasive meningococcal disease dating back to the 16th century, Vieusseux was the first to describe a European outbreak of “spotted fever” that claimed 33 lives in Geneva. He dubbed the disease “Fièvre cérébrale maligne non contagieuse” (noncontagious malignant cerebral fever), which he hypothesized was spread by bad air.
      • Manchanda V.
      • Gupta S.
      • Bhalla P.
      Meningococcal disease: history, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention.
      In 1806, Danielson and Mann
      • Danielson L.
      • Mann E.
      The history of a singular and very mortal disease which lately made its appearance in Medfield.
      described a presumed meningococcal outbreak of “malignant spotted fever” in North America, where 9 people died over a 1-month period. A bacterial cause was found in 1887 by the Austrian pathologist Anton Weichselbaum. He identified Neisseria meningitides (then Diplococcus intracellularis meningitides) in the cerebrospinal fluid of patients with “epidemic cerebrospinal meningitis.”
      • de Souza A.L.
      • Seguro A.C.
      Two centuries of meningococcal infections: from Vieusseux to the cellular and molecular basis of disease.
      Thirty years later, Herrick
      • Herrick W.W.
      Extrameningeal meningococcus infections.
      • Herrick W.W.
      Meningococcus infections including meningitis.
      described the extrameningeal signs of meningococcal infections in soldiers: “Almost diagnostic is the hemorrhagic rash. Pathologically this consists of minute hemorrhages into the skin. Usually of pinhead size, these may reach a diameter of several inches or in fulminating cases amount to a diffuse purpura. Like other hemorrhagic rashes, they do not disappear on pressure. They continue bright for 2 or 3 days when they fade leaving a rusty stain. Most commonly they occur about the shoulder and pelvic girdle; in more severe cases, over the trunk, conjunctivae, mucosa, extremities, even the face. They come out very quickly and within 1 to 2 hours a patient previously without skin lesions may show an astounding number of these spots. From these the ancient term ‘spotted fever’ arises.”
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Manchanda V.
        • Gupta S.
        • Bhalla P.
        Meningococcal disease: history, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention.
        Indian J Med Microbiol. 2006; 24: 7-19
        • Danielson L.
        • Mann E.
        The history of a singular and very mortal disease which lately made its appearance in Medfield.
        Med Agric Reg. 1806; 1: 65-69
        • de Souza A.L.
        • Seguro A.C.
        Two centuries of meningococcal infections: from Vieusseux to the cellular and molecular basis of disease.
        J Med Microbiol. 2008; 57: 1313-1321
        • Herrick W.W.
        Extrameningeal meningococcus infections.
        Arch Intern Med. 1919; 23: 409-418
        • Herrick W.W.
        Meningococcus infections including meningitis.
        Bull NY Acad Med. 1931; 7: 487-501
        • Brandtzaeg P.
        • Kierulf P.
        • Gaustad P.
        • et al.
        Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease.
        J Infect Dis. 1989; 159: 195-204
        • Heilmeyer L.
        Endotoxin skin inflammation and the Sanarelli-Shwartzman phenomenon.
        Med Klin. 1968; 63: 244-246
        • Pathan N.
        • Faust S.N.
        • Levin M.
        Pathophysiology of meningococcal meningitis and septicaemia.
        Arch Dis Child. 2003; 88: 601-607
        • Faust S.N.
        • Levin M.
        • Harrison O.B.
        • et al.
        Dysfunction of endothelial protein C activation in severe meningococcal sepsis.
        N Engl J Med. 2001; 345: 408-416
        • Nielsen H.E.
        • Anderen E.A.
        • Andersen J.
        • et al.
        Diagnostic assessment of haemorrhagic rash and fever.
        Arch Dis Child. 2001; 85: 160-165
        • Lasczkowski G.
        • Risse M.
        • Gamerdinger U.
        • Weiler G.
        Pathogenesis of conjunctival petechiae.
        Forensic Sci Int. 2005; 147: 25-29
        • Brandtzaeg P.
        • Ovsteboo R.
        • Kierulf P.
        Compartmentalization of lipopolysaccharide production correlates with clinical presentation in meningococcal disease.
        J Infect Dis. 1992; 166: 650-652
        • Caputo G.L.
        • Baldwin G.
        • Alpert G.
        • et al.
        Effect of meningococcal endotoxin in a rabbit model of shock.
        Circ Shock. 1992; 36: 104-112
        • Thompson M.J.
        • Ninis N.
        • Perera R.
        • et al.
        Clinical recognition of meningococcal disease in children and adolescents.
        Lancet. 2006; 367: 397-403
        • Arend S.M.
        • Lavrijsen A.P.M.
        • Kuijken I.
        • et al.
        Prospective controlled study of the diagnostic value of skin biopsy in patients with presumed meningococcal disease.
        Eur J Clin Microbiol Infect Dis. 2006; 25: 643-649