The Skin Lesions in Meningococcus Septicemia

Abstract

The skin lesions in acute infectious diseases are among the important and most easily determined clinical findings. Their cause, in some instances, has been explained on the basis of the presence of toxic substances, and in other instances it has been shown positively to be due to the presence of microorganisms. The hemorrhagic, purpuric and petechial lesions belong especially to this latter group. The demonstration of typhoid bacilli in the "rose spots," of streptococci in the skin lesions associated with streptococcus septicemia and subacute bacterial endocarditis, of tubercle bacilli in the petechiae or tuberculids seen in acute miliary tuberculosis, are the most striking examples of this type of etiology.The meningococcemia preceding or associated with acute epidemic cerebrospinal meningitis is manifest in some cases by the appearance of skin lesions of a petechial or purpuric nature. This characteristic has gained the terms "spotted fever," "black fever" and "petechial fever" for the disease. The existence of a meningococcemia in a considerable percentage of meningococcus infections has been demonstrated many times and in the hands of many observers, both by cultures and smears. Andrewes,1 in 1906, Coles,2 in 1915, King,3 in 1918, and many others have shown the organisms in blood smears.The study of the skin lesions is less frequently reported. Benda,4 in 1916, studied three cases ofJmeningitis with petechiae, in which he found a purpuric condition, and inflammatory foci with polymorpho¬ nuclear infiltration about the arterioles. In one of these cases, the most fulminating in character, he found groups of gram-negative cocci which he thought were meningcocci.