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Chronic meningococcemia
Other Resources UpToDate PubMed

Chronic meningococcemia

Contributors: Erin X. Wei MD, Susan Burgin MD
Other Resources UpToDate PubMed


Chronic meningococcemia is a rare, recurring, chronic infection of Neisseria meningitidis, which typically presents with an acute febrile illness. Chronic meningococcemia is typically associated with serogroup B N meningitidis. It can affect both adults and children. There are associated myalgias, arthralgias, anorexia, weight loss, and mild headaches that tend to recur cyclically in association with fever. If left untreated, chronic meningococcemia can evolve into life-threatening acute meningococcemia, meningitis, or endocarditis. This disease is more common in individuals lacking a terminal component of the complement pathway, but it has also been described in other individuals who have not been vaccinated against N meningitidis.

Symptoms typically persist for a few days, resolve, and then recur. Afebrile periods can last for days to more than a week. Patients feel healthy between episodes. Skin lesions can be macular, papular, nodular, petechial, or polymorphous. Joint pain typically affects the ankles and knees. Average duration of disease is approximately 1.5-3 months, depending on the case series, and tends to be shorter in children (persisting for 7 weeks to 2 months).

Blood cultures are initially negative in early disease in both children and adults, with earlier positivity on average in children. Thus, blood cultures need to be repeated. Blood culture during febrile periods is thought to be of the highest yield.


A39.3 – Chronic meningococcemia

240426001 – Chronic meningococcemia

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Differential Diagnosis & Pitfalls

  • Disseminated gonorrhea can present similarly and is easily mistaken for chronic meningococcemia.
  • Atypical measles
  • Cytomegalovirus infection
  • Thrombotic thrombocytopenic purpura (TTP)
  • Rocky Mountain spotted fever
  • Rheumatic fever and heart disease
  • Adult onset Still disease
  • Noninfectious vasculitis, eg, Leukocytoclastic vasculitis
  • Lyme disease

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Last Reviewed:11/18/2020
Last Updated:11/18/2020
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Chronic meningococcemia
A medical illustration showing key findings of Chronic meningococcemia : Headache, Rash, Recurring episodes or relapses, Anorexia, Arthralgia, Myalgia
Clinical image of Chronic meningococcemia - imageId=50545. Click to open in gallery.  caption: 'Petechiae and purpuric papules arising within erythematous patches on the dorsal foot.'
Petechiae and purpuric papules arising within erythematous patches on the dorsal foot.
Copyright © 2024 VisualDx®. All rights reserved.