Meningococcal sepsis and purpura fulminans: the surgical perspective

Morris, Marvin E.; Maijub, John G.; Walker, Scott G.; Gardner, Glenn P.; Jones, R. Watson

doi:10.1136/postgradmedj-2012-130989

Cited by 12 publications

(21 citation statements)

References 42 publications

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“…Clinical presentation shows acute disseminated intravascular coagulation (DIC), hemorrhagic necrosis of the skin, hypotension, and fever [1, 2]. PF may herald multiple organ failure (MOF) caused by thrombotic occlusion of small- and medium-sized blood vessels.…”

Section: Introductionmentioning

confidence: 99%

Identification of Differentially Expressed Serum Proteins in Infectious Purpura Fulminans

Han

et al. 2014

Disease Markers

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Purpura fulminans (PF) is a life-threatening hemorrhagic condition. Because of the rarity and randomness of the disease, no improvement in treatment has been made for a long time. In this study, we assessed the serum proteome response to PF by comparing serum proteins between healthy controls and PF patient. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) approach was used after depleting 6 abundant proteins of serum. In total, 262 proteins were confidently identified with 2 unique peptides, and 38 proteins were identified significantly up- (≥2) or downregulated (≤0.5) based on spectral counting ratios (SpCPF/N). In the 38 proteins with significant abundance changes, 11 proteins were previously known to be associated with burn or sepsis response, but 27 potentially novel proteins may be specifically associated with PF process. Two differentially expressed proteins, alpha-1-antitrypsin (SERPINA1) and alpha-2 antiplasmin (SERPINF2), were validated by Western blot. This is the first study where PF patient and healthy controls are compared in a proteomic study to elucidate proteins involved in the response to PF. This study provides an initial basis for future studies of PF, and the differentially expressed proteins might provide new therapeutic targets to decrease the mortality of PF.

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Section: Introductionmentioning

confidence: 99%

Identification of Differentially Expressed Serum Proteins in Infectious Purpura Fulminans

Han

et al. 2014

Disease Markers

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“…Initial interventions in such patients are largely medical, aimed at resolving the inciting sepsis via antibiotic therapy [1]. However, early surgical consultation is important given the high incidence of compartment syndrome, and consequently limb loss, in these patients [3]. A retrospective review of nine patients with acute infectious purpura fulminans and evidence of compartment syndrome on early surgical exploration found a mortality rate of 44% (4/9), and in survivors, an amputation rate of 80% (4/5) [4].…”

Section: Discussionmentioning

confidence: 99%

“…Interventions in compartment syndrome can include fasciotomy, which is typically effective in limb preservation if performed early in the disease course, ideally within 6 h of onset [1, 3]. However, there is less evidence for the effects of fasciotomy on skin necrosis [3].…”

Section: Discussionmentioning

confidence: 99%

Penile necrosis secondary to purpura fulminans: a case report and review of literature

Hogarth

Cheon

Kassam

et al. 2017

Journal of Surgical Case Reports

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We report the case of a 60-year-old Hispanic male with widespread necrotic purpuric lesions involving the penile, suprapubic, inguinal and hip dermis due to purpura fulminans. Purpura fulminans describes a rare syndrome involving intravascular thrombosis and hemorrhagic infarction of the skin; this rapidly progressing syndrome features vascular collapse and disseminated intravascular coagulation. This patient’s penile necrosis involved the majority of the penile shaft and glans penis, and ultimately required partial glansectomy and repeated debridement for treatment. Subsequently, full thickness skin grafting was completed for reconstruction with good effect. While reports of penile necrosis secondary to various causes are documented in the literature, no prior reports describe penile necrosis secondary to purpura fulminans.

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“…In particular, immediately start of antibiotics is utmost important, as meningococcal bacteria have an aggressive growth rate with a doubling time of only 30 to 45 minutes, thus leaving a narrow window of opportunity to fend off fulminant septicemia and DIC. 38,39 Patients should ideally be treated in a burn center, where team and infrastructure are prepared to treat critically ill patients with large skin and soft tissue lesions. Surgeons are usually consulted when diagnosis of PF has already been established.…”

Section: Purpura Fulminans: What Are the Solutions Acute Surgical Manmentioning

confidence: 99%

Management of Septic Skin Necroses

Mazzone

Schiestl

2013

Eur J Pediatr Surg

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Necrotizing fasciitis (NF) and purpura fulminans (PF) are conditions with extensive septic skin necroses that are associated with significant morbidity and mortality. NF is caused by fulminant bacterial spread on the superficial muscle fascia, Group A streptococcus being the main microorganism responsible for it. The major challenge NF poses is timely recognition. Although crucial for patient survival, early diagnosis is difficult because paucity of specific early findings does not allow setting NF apart from other, less severe, differential diagnoses. Surgical therapy consists of early and aggressive debridement of all affected tissue, even if large disfiguring wounds are left back. The responsible microorganism for PF in children is predominantly Neisseira meningitidis. Endotoxin triggered misbalance of anticoagulant and procoagulant activities of endothelial cells leads to disseminated intravascular coagulation (DIC) followed by microvascular thrombosis and bleeding, resulting in hemorrhagic skin infarction and limb ischemia. Although survival in PF is not dependent on surgery, and surgery plays not a key role in the early phase of the disease, early surgical consult to assess if limb perfusion can be improved to achieve limb salvage is still absolutely necessary. Debridement should be postponed until clear demarcation has established. Large defects after NF and PF can be successfully reconstructed with vacuum-assisted fixation of Integra (Integra LifeSciences Corporation, Plainsboro, New Jersey, United States) artificial skin before split-thickness skin grafting. This provides good functional and cosmetic results as well as good stump coverage in case of amputation in PF.

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Meningococcal sepsis and purpura fulminans: the surgical perspective

Cited by 12 publications

References 42 publications

Identification of Differentially Expressed Serum Proteins in Infectious Purpura Fulminans

Identification of Differentially Expressed Serum Proteins in Infectious Purpura Fulminans

Penile necrosis secondary to purpura fulminans: a case report and review of literature

Management of Septic Skin Necroses

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