Immune thrombocytopenic purpura associated with Brucella and Toxoplasma infections

Abstract

Bacterial and protozoal infections can cause thrombocytopenia and may mimic idiopathic thrombocytopenic purpura (ITP). Brucella species and Toxoplasma are among the infectious agents with protean clinical manifestations which may induce immune thrombocytopenia. In rare cases, thrombocytopenia can be severe and may result bleeding into the skin and from mucosal sites. Prompt recognition of this complication and aggressive therapy are essential, since the mortality associated with bleeding into the central nervous system is high. We report two patients with complaints of severe epistaxis and thrombocytopenia associated with brucellosis and toxoplasmosis. Thrombocytopenic purpura in these cases responded well to the high-dose corticosteroid treatment with platelet recovery within 2-3 days. For cases with infection-induced immune thrombocytopenic purpura, short-term high-dose corticosteroids may be applied as an urgent therapy without worsening of the clinical condition. Am. J. Hematol. 74:52-54, 2003.

Evaluation of mean platelet volume (MPV) levels in brucellosis patients

“…Immune-mediated thrombocytopenia may also occur during the course of brucellosis [6] And an inflammatory process occurs in brucellosiscausing increase in acute phase reactants [29,30].…”

“…Isolated thrombocytopenia (platelets <150x109/L) was seen in 8% of cases in a study reported from Turkey [6]. Immune-mediated thrombocytopenia may also occur during the course of brucellosis [7].…”

Intravenous gamma globulin is effective as an urgent treatment in Brucella‐induced severe thrombocytopenic purpura

“…Thrombocytopenia related to systemic infections may be due to a variety of causes: hypersplenism, bone marrow suppression, disseminated intravascular coagulation, increased clearance, immune-mediated destruction, hemophagocytosis, and adherence to damaged vascular surfaces [4][5][6][7][8][9][10]. The data is presently insufficient regarding the management of Brucella-associated bleeding and the time for antimicrobial therapy to take effect [10,11]. In this report, we discuss the management of a Turkish patient with brucellosis who presented with bleeding as the first manifestation of illness due to severe thrombocytopenia.…”

“…Thrombocytopenia, reported in 1-26% of cases, can cause bleeding in only very rare cases [1][2][3]. Thrombocytopenia related to systemic infections may be due to a variety of causes: hypersplenism, bone marrow suppression, disseminated intravascular coagulation, increased clearance, immune-mediated destruction, hemophagocytosis, and adherence to damaged vascular surfaces [4][5][6][7][8][9][10]. The data is presently insufficient regarding the management of Brucella-associated bleeding and the time for antimicrobial therapy to take effect [10,11].…”

An Uncommon Case of Acute Brucellosis Presenting with Severe Thrombocytopenia

“…Immune-mediated thrombocytopenia is a clinically important mechanism that may be encountered during the course of brucellosis (11,12). Brucella-associated thrombocytopenia can be associated with hypersplenism, autoimmune destruction due to the development of antithrombocyte antibodies, disseminated intravascular coagulopathy (DIC), hemophagocytosis and granulomas in bone marrow (6,9,11,13,14).…”