Association of Virulence Mechanisms with Specific Meningococcal Infections Specific disease manifestations of meningococcal infections have specific virulence and pathogenic mechanisms, as described below for fulminant meningococcemia and meningitis. Fulminant Meningococcemia Purpura Fulminans Fulminant meningococcemia is perhaps the most rapidly lethal form of septic shock experienced by humans. It differs from most other forms of septic shock by the prominence of hemorrhagic skin lesions (petechiae, purpura; see Fig. 52-5) and the consistent development of DIC. The dominant proinflammatory molecule in the meningococcal cell wall is the endotoxin or LOS, and the outer membrane that contains it is poorly tethered to the underlying peptidoglycan
