Infections and Thrombocytopenia

Febrile patient with thrombocytopenia is commonly encountered by physicians especially during monsoon and perimonsoon period. Infections with protozoa, bacteria and viruses can cause thrombocytopenia with or without disseminated intravascular coagulation. Commonly dengue, malaria, scrub typhus and other rickettsial infections, meningococci, leptospira and certain viral infections present as fever with thrombocytopenia. Occasionally these patients can go on to develop a stormy course with multiorgan dysfunction requiring intensive care unit admission associated with high morbidity and mortality.1,2 Infections cause decrease in platelet count both due to effects on platelet production and platelet survival.3 Thrombocytopenia in bacterial infections can occur as a part of sepsis with disseminated intravascular coagulation. Patients with sepsis may also develop hemophagocytic histiocytosis with phagocytosis of platelets and leucocytes in the bone marrow histiocytes. Both Gram-positive and Gram-negative bacterial infections can lead to sepsis. Elevated platelet-associated IgG has been implicated. Platelets tend to adhere to damaged vascular surfaces in meningococcemia.