Purpura fulminans secondary to Xanthomonas maltophilia sepsis in an adult with aplastic anemia

Stenotrophomonas maltophilia infection of the central venous catheter and lysis of an old thrombosis in a post-bone marrow transplantation child: Implications in the fibrinolytic process

In this report, we describe an 11-y-old girl who developed jugular venous thrombosis after allogeneic bone marrow transplantation for lymphoma and then experienced dissolution of the thrombosis following catheter-related Stenothrophomonas maltophilia bactearemia. The lysis of the old thrombosis around the central venous catheter suggested a local fibrinolytic activity of S. maltophilia. The global fibrinolytic capacity (GFC) was also tested in vitro by using S. maltophilia cultures obtained from the present patient; GFC of the patient was compared to that of another isolate of S. maltophilia, other bacteria (S. pyogenes and E. coli), and control plasma. The fibrinolytic capasity of S. maltophilia was significantly higher than that of the control plasma (p<0.05) and almost equal to that of S. pyogenes (p>0.05). Thus, if a potent local fibrinolytic activity of S. maltophilia is evident, the use of the fibrinolytic enzyme of S. maltophilia as a thrombolytic agent may be a useful therapeutic adjunct in the future. Further studies are needed to comfirm the results obtained in the present study.

Acute infectious purpura fulminans associated with asplenism or hyposplenism

Acute infectious purpura fulminans is a rapidly progressive syndrome of hemorrhagic skin necrosis associated with acute infection and disseminated intravascular coagulation. We report 5 cases of purpura fulminans and briefly review the literature. All cases were associated with encapsulated organisms (Streptococcus pneumoniae or Group A streptococcus), and 4 of the 5 patients had asplenism or functional hyposplenism.

Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans

LEARNING OBJECTIVES

After studying the article, the participant should be able to: 1. Describe the most common bacteriology of necrotizing fasciitis and purpura fulminans. 2. Describe the "finger test" in the diagnosis of necrotizing fasciitis. 3. Discuss the three presentation patterns of necrotizing fasciitis. 4. Discuss the pathophysiology of acute infectious purpura fulminans. 5. Discuss the treatment strategies for necrotizing fasciitis and purpura fulminans, including the use of artificial skin substitutes. Necrotizing fasciitis and purpura fulminans are two destructive processes that involve skin and soft tissues. The plastic and reconstructive surgeon may frequently be called on for assistance in the diagnosis, treatment, and/or reconstruction of patients with these conditions. Understanding the natural history and unique characteristics of these processes is essential for effective surgical management and favorable patient outcome. A comprehensive review of the literature pertaining to these two conditions is presented, outlining the different pathophysiologies, the patterns of presentation, and the treatment strategies necessary for successful management of these massive infectious soft-tissue diseases.

Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia

The gram-negative bacterium Stenotrophomonas maltophilia is increasingly recognized as an important cause of nosocomial infection. Infection occurs principally, but not exclusively, in debilitated and immunosuppressed individuals. Management of S. maltophilia-associated infection is problematic because many strains of the bacterium manifest resistance to multiple antibiotics. These difficulties are compounded by methodological problems in in vitro susceptibility testing for which there are, as yet, no formal guidelines. Despite its acknowledged importance as a nosocomial pathogen, little is known of the epidemiology of S. maltophilia, and although it is considered an environmental bacterium, its sources and reservoirs are often not readily apparent. Molecular typing systems may contribute to our knowledge of the epidemiology of S. maltophilia infection, thus allowing the development of strategies to interrupt the transmission of the bacterium in the hospital setting. Even less is known of pathogenic mechanisms and putative virulence factors involved in the natural history of S. maltophilia infection and this, coupled with difficulties in distinguishing colonization from true infection, has fostered the view that the bacterium is essentially nonpathogenic. This article aims to review the current taxonomic status of S. maltophilia, and it discusses the laboratory identification of the bacterium. The epidemiology of the organism is considered with particular reference to nosocomial outbreaks, several of which have been investigated by molecular typing techniques. Risk factors for acquisition of the bacterium are also reviewed, and the ever-expanding spectrum of clinical syndromes associated with S. maltophilia is surveyed. Antimicrobial resistance mechanisms, pitfalls in in vitro susceptibility testing, and therapy of S. maltophilia infections are also discussed.