<prompt> Young female with 3 day fever presents with headache, BP 9060 mmHg, Hea rate of 114min, and pin point spots developed distal to BP cuff. Most likely organism is:Brucella abousBrucella suisN. meningitidisStaphylococcus aureus  <response>: Ans. c. i.e. N. meningitidis The patient here is under state of shock hypotension, tachycardia in conjunction with meningitis headache feverand rash. Meningococcal meningitis is the most common meningitis complicated by shock. CLINICAL MANIFESTATION OF MENINGOCOCCAL DISEASE Rash A nonblanching rash petechial or purpuric develops in 80 of cases of meningococcal disease. Rashesare initially blanching in nature but within hours become non-blanching. In severe cases large purpuriclesions purpura fulminons develops. Meningitis Commonly present as fever, vomiting, headache, irritability, petechial or purpuric rash occurs in 23 of cases. Headache is seen in adults usually. In upto 40 of cases there are some features of septicemia too. Septicemia Can be isolated or as a accomplication of meningitis. The condition may cause death within hours. Purpura fulminans is a specific feature. Chronic meningococcemia Present as repeated episodes of petechial rash associated with fever joint pain, ahritis and splenomegaly. The main differential diagnosis is acute rheumatic fever. This condition has been associated with complement deficiently and with inadequate sulfonamide therapy. If left untreated chances of progression to meningococcal septicemia are high. Postmeningococcal reactive disease In small propoion of patients, an immune complex disease develops 4-10 days after the onset of meningococcal disease with manifestations that include a maculopapular or vasculitic rash, ahritis, pericarditis andor polyserosites associated with fever. 