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Purpura fulminans due to Staphylococcus aureus
Gary R Kravitz1, David J Dries, Marnie L Peterson
1St. Paul Infectious Disease Associates, St. Paul, Minnesota, USA.
Summary
Staphylococcus aureus strains producing superantigens can cause purpura fulminans, a severe condition. This emerging illness requires medical awareness due to its high mortality rate.
Area of Science:
- Infectious Diseases
- Toxicology
- Dermatology
Background:
- Purpura fulminans is a severe condition typically linked to meningococcal or streptococcal infections.
- It involves disseminated intravascular coagulation and distinctive purpuric skin lesions.
- This study investigates a novel association with Staphylococcus aureus.
Observation:
- Five cases of purpura fulminans linked to Staphylococcus aureus strains producing superantigens were identified.
- The strains produced toxic shock syndrome toxin-1 (TSST-1), staphylococcal enterotoxin B (SEB), or staphylococcal enterotoxin C (SEC).
- In some cases, infection was not septicemic, suggesting exotoxin involvement.
Findings:
- Staphylococcus aureus strains were isolated from blood or respiratory tracts.
- Methicillin-resistant Staphylococcus aureus (MRSA) strains producing SEC and Panton-Valentine leukocidin (PVL) were identified in a severe case.
- Mortality was high, with only 2 of 5 patients surviving.
Implications:
- Staphylococcal purpura fulminans may represent an emerging clinical entity.
- Superantigen production by Staphylococcus aureus is implicated in this severe condition.
- Healthcare providers should be vigilant for this potentially fatal illness.