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[Increased vascular permeability during endotoxinemia in the child (author's transl)]
Insights
Bacterial endotoxins may increase vascular permeability in children with meningococcal sepsis or shock. Lower plasma protein levels indicate increased vascular permeability, even with hemoconcentration.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- The precise impact of bacterial endotoxins on vascular permeability remains debated.
- Clinical observations suggest a link between sepsis/shock and altered vascular integrity.
Purpose of the Study:
- To investigate the effect of Neisseria meningitidis infection on vascular permeability in children.
- To correlate clinical presentation severity with plasma protein levels.
Main Methods:
- A cohort of 133 children with severe Neisseria meningitidis infection was studied.
- Patients were stratified into three groups based on initial clinical severity.
- Plasma protein levels were measured on admission and during the initial 24 hours of treatment.
Main Results:
- Children with sepsis or shock exhibited significantly lower mean plasma protein levels.
- Hypoproteinemia worsened during the first 24 hours, independent of hemodilution or caloric intake.
- The rate of decrease in protein concentrations correlated inversely with molecular weight, suggesting selective macromolecule leakage.
Conclusions:
- Early meningococcal septicemia and shock are associated with increased vascular permeability.
- Vascular membranes maintain selectivity for macromolecules during these conditions.
- Findings contribute to understanding the pathophysiology of meningococcal disease complications.
Abstract:
There is no uniform agreement about the effects of bacterial endotoxins upon vascular permeability. We presently report some clinical observations indicating an increase in vascular permeability during sepsis and shock related to Neisseria meningitidis in children. 133 children, admitted for a severe infection due to Neisseria m. were separated into three groups according to the severity of the initial clinical picture. The patients presenting with a sepsis or shock had significantly lower mean plasma protein levels on admission. This was not related to any hemodilution or caloric deficiency. Hypoproteinemia worsened during the 24 first hours of treatment, despite hemoconcentration as presented by some patients [12]. The speed of decrease in protein concentrations was inversely related to the molecular weights of the different protein fractions. These observations indicate an increase in vascular permeability with maintainance of vascular membrane selectivity to macromolecules during early meningococcic septicemia and shock.