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Myocardial injury in meningococcus-induced purpura fulminans in children

G Briassoulis1, M Narlioglou, N Zavras

  • 1Pediatric Intensive Care Unit, Aghia Sophia Children's Hospital, Athens, Greece. briassg@otenet.gr

Intensive Care Medicine
|August 11, 2001
PubMed

Insights

Myocardial ischemia is common in pediatric meningococcemia, indicated by elevated cardiac troponin I (cTnI). High cTnI levels correlate with coagulopathy and impaired heart function, suggesting a need for early intervention.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Meningococcemia can lead to severe complications, including purpura fulminans.
  • Myocardial involvement in pediatric meningococcemia is not well-characterized.

Purpose of the Study:

  • To determine the incidence of myocardial ischemia in pediatric patients with meningococcus-induced purpura fulminans.
  • To correlate cardiac troponin I (cTnI) levels with electrocardiogram (ECG) changes, myocardial function, and coagulopathy.
  • To evaluate the relationship between cTnI and disease severity.

Main Methods:

  • Studied 22 pediatric patients with acute meningococcemia requiring inotropic or vasoactive support.
  • Daily monitoring of serum cTnI, myocardial ischemia markers, and coagulopathy markers.
  • Daily measurements of cardiac index, ejection fraction, shortening fraction, and ECGs.

Main Results:

  • Five patients (23%) presented with myocardial ischemia, characterized by elevated cTnI levels and depressed myocardial contractility.
  • High cTnI levels correlated significantly with low levels of protein C, factor VIII, and antithrombin III.
  • Myocardial ischemia was not associated with clinical prognostic scores or inotropic support.

Conclusions:

  • Myocardial ischemia is increased in pediatric acute meningococcemia and linked to myocardial dysfunction.
  • Elevated cTnI indicates severe coagulopathy but not necessarily poor prognosis based on clinical scores.
  • Early detection of myocardial injury and prompt replacement therapy may improve outcomes.
Abstract

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