Yung Allen P, McDonald Malcolm I
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
Med J Aust. 2003 Feb 3;178(3):134-7. doi: 10.5694/j.1326-5377.2003.tb05106.x.
Meningococcal septicaemia has high mortality, especially when the diagnosis is delayed or missed. Early recognition is not always straightforward, as classic clinical features may be absent or overlooked at initial presentation. Septicaemia without focal infection accounts for 15%-20% of cases of meningococcal disease and is the most worrisome manifestation in terms of diagnosis and outcome; in contrast, meningococcal meningitis is usually straightforward to diagnose, with a relatively good prognosis. Useful early clinical clues to meningococcaemia include: - a haemorrhagic (petechial or purpuric) rash; - blanching macular or maculopapular rash that appears in first 24 hours of illness; - true rigors; - severe pain in extremities, neck or back; vomiting, especially in association with headache or abdominal pain; rapid evolution of the illness; - concern of parents, relatives or friends; - patient age (highest incidence at age 3-12 months, followed by 1-4 and then 15-19 years); and - contact with a patient with meningococcal disease. In addition to specific clues, clinicians should look at the whole pattern of the illness. Timely clinical review is essential if there is doubt about the diagnosis. In any acutely febrile patient, it is prudent to ask "Why is this patient seeking help now?", then "Could this patient have meningococcaemia?".
脑膜炎球菌血症死亡率很高，尤其是诊断延误或漏诊时。早期识别并非总是一目了然，因为初始就诊时可能没有或忽略了典型临床特征。无局灶性感染的败血症占脑膜炎球菌病病例的15%-20%，就诊断和预后而言是最令人担忧的表现；相比之下，脑膜炎球菌性脑膜炎通常诊断容易，预后相对较好。脑膜炎球菌血症有用的早期临床线索包括： - 出血性（瘀点或紫癜性）皮疹； - 病程最初24小时内出现的可褪色斑疹或斑丘疹； - 真正的寒战； - 四肢、颈部或背部剧痛；呕吐，尤其是伴有头痛或腹痛时；病情快速进展； - 父母、亲属或朋友的担忧； - 患者年龄（3-12个月发病率最高，其次是1-4岁，然后是15-19岁）；以及 - 与脑膜炎球菌病患者接触。除了特定线索外，临床医生应审视疾病的整体模式。如果对诊断有疑问，及时进行临床复查至关重要。对于任何急性发热患者，谨慎的做法是先问“为什么这个患者现在来寻求帮助？”，然后问“这个患者会是脑膜炎球菌血症吗？”
