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Meningococcal purpura fulminans treated with medicinal leeches
Ricky Dippenaar1, Johan Smith, Pierre Goussard
1Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Children's Hospital, Tygerberg, South Africa.
Introduction:
Meningococcal septicemia remains one of the most common infectious causes of admission to a pediatric intensive care unit. Numerous treatment strategies aimed at the thromboembolic complications inducing purpura fulminans and limb/digital ischemia have been attempted, with variable results. The successful use of medicinal leeches for pneumococcal purpura fulminans has been described, and we present a similar case of meningococcal purpura fulminans.
Patient And Intervention:
A 5-wk-old female infant with meningococcal meningitis and septicemia and progressive purpura fulminans of the left hand was treated with medicinal leeches. Medicinal leeches were applied to the left dorsal hand on a daily basis for 4 consecutive days.
Result:
The swelling and limited functionality visibly improved after 48 hrs, and by 120 hrs, perfusion in the distal phalanges of the thumb and middle finger was evident. Reperfusion of the distal phalanges was not fully sustained, and at 6 wks the plastic surgery department debrided the distal phalanges of her left hand, excluding the thumb. She fully recovered from the meningococcal septicemic shock; the functionality of her left thumb was preserved, and she has limited functionality of her left hand.
Conclusion:
The unique combination of salivary products in leech therapy has theoretical benefits and requires future study.
Insights
Medicinal leech therapy showed promise in treating a severe case of meningococcal purpura fulminans in an infant, improving limb perfusion. While not a complete solution, it offers potential benefits for this critical condition.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Vascular Surgery
Background:
- Meningococcal septicemia is a leading cause of pediatric intensive care unit admissions.
- Purpura fulminans and limb ischemia are severe thromboembolic complications of meningococcal disease.
- Existing treatments for these complications have yielded variable results.
Observation:
- A 5-week-old infant presented with meningococcal meningitis, septicemia, and progressive purpura fulminans of the left hand.
- Medicinal leeches were applied daily for four consecutive days to the affected hand.
- Initial improvements in swelling and functionality were observed within 48 hours.
Findings:
- Perfusion in the distal phalanges of the thumb and middle finger became evident by 120 hours.
- Full reperfusion was not sustained, necessitating debridement of distal phalanges at 6 weeks.
- The infant recovered from septic shock, with preserved thumb functionality and limited hand function.
Implications:
- Leech therapy, utilizing unique salivary components, presents a potential adjunctive treatment for purpura fulminans.
- Further research is warranted to explore the therapeutic benefits of leech saliva in managing severe meningococcal complications.
- This case highlights an alternative approach to limb salvage in pediatric purpura fulminans.
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