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Electrolyte changes caused by hydrotherapy in purpura fulminans
R S Abrams1, L S Nichter, G M Sloan
1Division of Plastic Surgery, Childrens Hospital of Los Angeles, CA 90054-0700.
The Journal of Burn Care & Rehabilitation
|September 1, 1988
Summary
Purpura fulminans, a severe meningococcemia complication, often leads to gangrenous lesions. Early surgical intervention for these necrotic areas is challenging due to disease pathophysiology, impacting survival and treatment outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Critical Care Medicine
Background:
- Purpura fulminans is a rare, severe complication of meningococcemia with a high mortality rate.
- Survivors often develop extensive gangrenous lesions, primarily affecting extremities and sometimes facial structures.
- The unique pathophysiology and distal circulatory involvement complicate timely demarcation and surgical management.
Observation:
- A 1986 outbreak in Southern California involved five pediatric cases (2 months to 6 years).
- Mortality was observed in one 2-month-old during the acute phase and a 6-year-old with progressive necrosis.
- Three survivors experienced varying degrees of necrotic lesions, with two requiring extensive management for limb necrosis.
Findings:
- Purpura fulminans presents a significant challenge in pediatric cases, with high mortality and morbidity.
- Gangrenous lesions in survivors are often extensive and difficult to manage surgically due to delayed demarcation.
- Electrolyte disturbances can be a complicating factor in affected children.
Implications:
- This study highlights the severe sequelae of purpura fulminans in children and the limitations of current treatment strategies.
- Improved understanding of the disease's pathophysiology is crucial for developing more effective early interventions.
- Further research is needed to optimize the management of necrotic lesions and improve outcomes for survivors.