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Surgical intervention for the complications of meningococcal-induced purpura fulminans
R Herrera1, P C Hobar, C M Ginsburg
1Division of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas.
Abstract:
Purpura fulminans is an infrequent but sometimes catastrophic illness that usually complicates a viral, rickettsial or bacterial infection. This communication presents a retrospective review of 152 patients with meningococcemia hospitalized at Children's Medical Center of Dallas from January, 1983, through December, 1993. Eighteen (11.9%) of the 152 patients developed purpura fulminans. Thirteen (72%) of the 18 patients with purpura fulminans needed one or more surgeries including skin grafts, local debridement, microvascular flaps or amputations. Five patients (28%) died.
Insights
Purpura fulminans, a severe complication of meningococcemia, frequently requires surgery and carries a significant mortality risk. This study highlights the aggressive nature of this condition in children.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Dermatology
Background:
- Purpura fulminans is a rare, life-threatening condition often associated with infections.
- Meningococcemia is a common cause of purpura fulminans in pediatric populations.
- Understanding the clinical course and outcomes of purpura fulminans is crucial for timely intervention.
Purpose of the Study:
- To retrospectively review patients with meningococcemia and identify the incidence of purpura fulminans.
- To analyze the surgical interventions and mortality rates associated with purpura fulminans in this cohort.
Main Methods:
- Retrospective chart review of 152 patients diagnosed with meningococcemia.
- Inclusion criteria: Hospitalization at Children's Medical Center of Dallas between 1983 and 1993.
- Data collection focused on the development of purpura fulminans, surgical procedures, and patient outcomes.
Main Results:
- Eighteen out of 152 patients (11.9%) with meningococcemia developed purpura fulminans.
- Seventy-two percent (13 of 18) of patients with purpura fulminans required surgical intervention, including skin grafts, debridement, flaps, or amputations.
- A mortality rate of 28% (5 of 18) was observed in patients with purpura fulminans.
Conclusions:
- Purpura fulminans is a significant complication of meningococcemia, necessitating aggressive management.
- The high rate of surgical intervention underscores the severity and tissue-damaging potential of this condition.
- The substantial mortality rate emphasizes the critical need for prompt diagnosis and treatment of purpura fulminans.