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Skin and extremity loss in meningococcal septicaemia treated in a burn unit
1Department of Plastic and Reconstructive Surgery, Northern General Hospital, Sheffield, UK.
Abstract:
Meningococcal septicaemia is a severe systemic illness which has an overall mortality of 15 per cent. It differs from meningococcal meningitis in clinical presentation, treatment, complications and prognosis. Skin and extremity loss are particular problems seen in meningococcal septicaemia. As critical care improves more patients are being seen with these complications. We report two patients in which these complications are demonstrated. Both patients underwent multiple autogenic and allogenic skin grafting procedures for skin loss. Apparently necrotic extremities were initially treated conservatively, with good results. The total area of necrotic tissue reduced dramatically with this treatment. Despite this, however, one patient required a Syme amputation, in the other, two toes on the affected foot separated painlessly at the metatarsophalangeal joint. We also discuss some of the pathophysiology behind skin necrosis. A popular view at present is that endotoxin from the cell wall of Neisseria meningiditis initiates the release of vasoactive cytokines by the host. High levels of interleukin-1 and interleukin-6 have been associated with a greater likelihood of fatality.
Insights
Meningococcal septicaemia can cause severe skin and extremity loss. Conservative treatment of necrotic extremities showed promising results, though amputation was still required in one case.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Dermatology
Background:
- Meningococcal septicaemia presents unique challenges distinct from meningitis, notably skin and extremity loss.
- Advances in critical care increase patient survival, leading to more frequent observation of these severe complications.
Observation:
- Two cases of meningococcal septicaemia with significant skin and extremity necrosis are presented.
- Patients underwent extensive skin grafting procedures for tissue loss.
- Conservative management of necrotic extremities yielded substantial reduction in necrotic tissue area.
Findings:
- Despite conservative measures, one patient required a Syme amputation.
- In another patient, two toes spontaneously separated painlessly.
- Pathophysiology involves Neisseria meningiditis endotoxin triggering cytokine release, with elevated IL-1 and IL-6 linked to fatality.
Implications:
- Conservative treatment may preserve extremities in some cases of meningococcal septicaemia-induced necrosis.
- Understanding cytokine pathways (IL-1, IL-6) is crucial for managing severe meningococcal disease.
- Further research into managing skin and extremity loss in meningococcal septicaemia is warranted.