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Systemic meningococcal disease: a model infection to study acute endotoxinemia in man
P Brandtzaeg1, P Kierulf, P Gaustad
1Department of Infectious Diseases, Ullevål University Hospital, Oslo, Norway.
Abstract:
Plasma LPS were quantitated in 40 patients with bacteriological verified systemic meningococcal infection (SMD). Twenty-two patients (55%) demonstrated LPS greater than 25 pg/ml. Fourteen patients with initial plasma LPS levels greater than 700 pg/ml developed a severe septic shock, impaired renal function and extensive coagulopathy compared to 2 out of 26 patients with LPS levels below 700 pg/ml. Seven patients died due to the circulatory collapse and multiple organ failure all with initial LPS levels greater than 1,000 pg/ml. Initiation of antibiotic therapy did not result in further increase of plasma LPS concentration. LPS were cleared from the circulation with a half-life of 1.5-3 hours after initiation of antibiotic treatment with penicillin and chloramphenicol. The results suggest that plasma LPS are quantitatively related to the development of septic shock, multiple organ failure and death from these complications in SMD, making LPS measurement a direct prognostic marker.
Insights
High levels of lipopolysaccharides (LPS) in patients with systemic meningococcal disease (SMD) correlate with severe outcomes like septic shock and death. LPS levels can serve as a prognostic marker for disease severity.
Area of Science:
- Microbiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Systemic meningococcal infection (SMD) is a serious condition.
- Lipopolysaccharides (LPS) are key components of Gram-negative bacteria, including Neisseria meningitidis.
Purpose of the Study:
- To investigate the quantitative relationship between plasma LPS levels and the clinical outcomes in patients with SMD.
- To evaluate LPS as a prognostic marker for severe disease complications.
Main Methods:
- Quantitation of plasma LPS levels in 40 patients diagnosed with bacteriological verified SMD.
- Correlation of initial LPS levels with the development of septic shock, renal dysfunction, coagulopathy, and mortality.
- Monitoring LPS clearance following antibiotic treatment.
Main Results:
- 55% of patients (22/40) had plasma LPS > 25 pg/ml.
- Patients with initial LPS > 700 pg/ml were more likely to develop severe septic shock, renal impairment, and coagulopathy (14/40) compared to those with lower levels (2/26).
- All seven non-survivors had initial LPS levels > 1,000 pg/ml, succumbing to circulatory collapse and multiple organ failure.
Conclusions:
- Plasma LPS levels are quantitatively associated with the severity of septic shock, multiple organ failure, and mortality in SMD.
- LPS measurement is a direct and valuable prognostic marker for predicting severe outcomes in systemic meningococcal infections.