Purpura fulminans in a child due to Neisseria meningitidis

The Diverse Spectrum of Invasive Meningococcal Disease in Pediatric and Adolescent Patients: Narrative Review of Cases and Case Series

INTRODUCTION

Invasive meningococcal disease (IMD) is a potentially life-threatening disease caused by Neisseria meningitidis infection. We reviewed case reports of IMD from newborns, infants, children, and adolescents, and described the real-life clinical presentations, diagnoses, treatment paradigms, and clinical outcomes.

METHODS

PubMed and Embase were searched for IMD case reports on patients aged ≤ 19 years published from January 2011 to March 2023 (search terms "Neisseria meningitidis" or "invasive meningococcal disease", and "infant", "children", "paediatric", pediatric", or "adolescent").

RESULTS

We identified 97 publications reporting 184 cases of IMD, including 25 cases with a fatal outcome. Most cases were in adolescents aged 13-19 years (34.2%), followed by children aged 1-5 years (27.6%), children aged 6-12 years (17.1%), infants aged 1-12 months (17.1%), and neonates (3.9%). The most common disease-causing serogroups were W (40.2%), B (31.7%), and C (10.4%). Serogroup W was the most common serogroup in adolescents (17.2%), and serogroup B was the most common in the other age groups, including children aged 1-5 years (11.5%). The most common clinical presentations were meningitis (46.6%) and sepsis (36.8%).

CONCLUSIONS

IMD continues to pose a threat to the health of children and adolescents. While this review was limited to case reports and is not reflective of global epidemiology, adolescents represented the largest group with IMD. Additionally, nearly half of the patients who died were adolescents, emphasizing the importance of monitoring and vaccination in this age group. Different infecting serogroups were predominant in different age groups, highlighting the usefulness of multivalent vaccines to provide the broadest possible protection against IMD. Overall, this review provides useful insights into real-life clinical presentations, treatment paradigms, diagnoses, and clinical outcomes to help clinicians diagnose, treat, and, ultimately, protect patients from this devastating disease.

Efficacy and safety of a hyperoxygenated fatty acid compound in improving the microcirculation of purpura fulminans in paediatric patients with sepsis: a pilot study

INTRODUCTION

Purpura fulminans (PF) is a serious complication of sepsis resulting from a set of alterations characterised by the development of ecchymotic haemorrhagic lesions and skin necrosis.

AIM

To analyse the efficacy and safety of the topical application of HOFA compound, in the cutaneous microcirculation of PF lesions in paediatric patients affected by sepsis.

MATERIAL AND METHODS

A prospective quasi-experimental pre-test/post-test single-group conducted in a Paediatric Intensive Care Unit of a third level hospital was performed. Paediatric patients aged 0-18 years with sepsis were included. Somatic oximetry values were measured before and after application of HOFAs every 4h over the first three days of the patients' hospitalisation. Patient's socio-demographic and clinical variables and somatic oximetry by placing a sensor for measuring tissue perfusion on the area with PF were determined.

RESULTS

Four patients were recruited, with a median age of 98 months. The purpuric lesions measured were mainly located on both feet and hands and, in two patients, also on the lateral malleoli and calves of both lower extremities. A total of 225 measurements were obtained, with mean pre-intervention scores of 71.17±15.65% versus 73.68±14.83% post-intervention. Statistical significance (p<0.001) was observed upon comparison of the pre- and post-intervention measurements.

CONCLUSIONS

Early and continued application of HOFAs in the management of sepsis-induced PF is an effective and safe practice in the cases analysed. In more than half of the episodes analysed, an increase in tissue microcirculation was observed after the application of HOFAs, with no adverse events.

Management of purpura fulminans skin lesions in a premature neonate with sepsis: a case study

Purpura fulminans is a severe and rapidly progressive septic process characterised by the development of haemorrhagic and ecchymotic lesions and skin necrosis. It can appear on any part of the body but predominantly affects the limbs. Purpura fulminans is a rare but possible complication in paediatric patients, especially neonates. It can increase their risk of morbidity and mortality if not treated early and cause a severe long-term condition in survivors of the infectious episode, including amputation. For professionals involved in wound healing, purpura fulminans poses a major challenge. This report describes the case of a premature neonate with extensive purpura fulminans of the legs and arms. Topical treatment of the limbs and purpuric areas with hyperoxygenated fatty acids (HOFAs) every two hours produced an improvement in the lesions. Complete healing was achieved using moist wound healing products. Early topical application of HOFAs appears to be a safe treatment that improves tissue microcirculation in paediatric patients with Purpura fulminans, minimising sepsis-related skin damage.

[Necrosis of maxilla secondary to purpura fulminans. A case report]

Purpura fulminans in infants is a rare, life-threatening condition mostly due to Neisseria meningitides. The condition is often fatal unless there is early recognition of the clinical symptoms, prompt diagnosis, and judicious replacement therapy. We observed a case of maxilla necrosis in a 5-month-old infant due to purpura fulminans. An acute necrotic process affecting the maxilla with denudation of bone and spontaneous exfoliation of teeth was noted. After 2 months, the patient was free of symptoms. To our knowledge, this is the first case report of necrosis of the maxilla secondary to a purpura fulminans. Prompt diagnosis and prompt medical intervention are necessary to avoid such complications.

Purpura Fulminans following Thermal Injury

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin, which is an unusual cutaneous manifestation of disseminated intravascular coagulation. It often occurs in small children and babies due to infection and/or sepsis, rarely in adults in clinic. We report the first case of deadly purpura fulminans following thermal injury in a 64-year-old Chinese woman. The purpura developed sharply and aggravated multiple organ dysfunction. The patient died of purpura fulminans, disseminated intravascular coagulation, and multiple organ dysfunction syndrome.