| • | often with partially treated gonorrhea |
| • | joint disease: (migratory arthritis that settles to one joint) |
| • | tenosynovitis – blood culture (+), fluid culture (-) |
| • | suppurative arthritis – blood culture (-), synovial fluid culture (+) (usually without skin lesions) |
| • | initially there may be macules, papule or vesicles with a red halo, but they soon develop into pustules or bullae which may become hemorrhagic or necrotic |
| • | occur early in one or more crops, each of which consists of relatively few lesions, usually <20 scattered over the limbs |
diagnosis:
| • | certain clinical diagnosis is usually impossible |
| • | mucosal infection is often asymptomatic, but a positive culture is often obtained from the site of primary infection |
| • | cannot culture organism from blood or pustules, only from original sight of infection oropharynx, cervix, and/or rectum are highest yield |
| • | (cause = local hypersensitivity; find antigen but no organism)??? |
| • | the pustule on a hemorrhagic base are distinctive but not pathognomonic (ddx – also occur in disseminated meningicoccus and acinetobacter spp.) |
Chronic gonococcemia and meningococcemia characterized by triad:
| • | (but they are ill in meningococcemia, and well-appearing in gonococcemia) |
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