The diagnosis of meningococcal disease is not always straightforward and often requires a high level of clinical suspicion. Early diagnosis with specific therapy results in less morbidity and mortality.
Red flags for meningococcemia in a patient with fever:
(1) lethargy, drowsiness or altered mental status
(2) confusion
(3) headache
(4) leg pains
(5) cold hand and/or feet
(6) rapid disease progression
(7) abnormal skin color (pallor or cyanosis)
Pitfalls - excluding the diagnosis because one or more of the following are absent:
(1) photophobia
(2) petechiae or hemorrhagic rash, especially if the patient has a dark skin color
(3) neck stiffness
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