|
|
|
|
|
| Acute infectious purpura fulminans caused by Streptococcus pyogenes: treatment and literature review |
| Wang Ben-chao, Jin Lin-xin, Chen Sen, Peng Hao |
| Department of Emergency Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China |
|
|
|
|
Abstract Objective To explore the changes of clinical symptoms, signs and auxiliary examination indexes of acute infectious purpura fulminans (AIPF) caused by acute infection of Streptococcus pyogenes, so as to provide reference for the diagnosis and treatment of AIPF. Methods This paper reviewed in detail the medical records, clinical manifestations, signs, laboratory examination results and diagnosis and treatment of death cases in undergraduate course, and combined two similar cases retrieved from the database by “fulminant purpura” and “Streptococcus pyogenes”, analysed and compared their clinical characteristics and treatment process, and probes into possible prevention and treatment measures. Results ①AIPF caused by Streptococcus pyogenes may be a special fulminant purpura good hair in the elderly. ②The course of AIPF caused by Streptococcus pyogenes was very fast with seriously inflammatory reaction. The PCT and CRP of it could be significantly increased, however, the inflammatory cells were reducing, and septic shock happened early. ③AIPF caused by Streptococcus pyogenes led to reducing PLT, increasing D-Dimer and coagulopathy. ④The infectious of Streptococcus pyogenes could spread through blood. ⑤AIPF caused by Streptococcus pyogenes can damage the function of liver, kidney, lung and heart, and cause electrolyte disorder or acid-base disorder. ⑥The myoglobin, creatine kinase and its isoenzyme increased significantly. Conclusion The effect of anti-infection treatment for AIPF caused by Streptococcus pyogenes is poor, and the prognosis of it is poor, there isn′t cure patients yet in China. Timely surgery for patients who can have an operation could be effective.
|
|
|
|
Corresponding Authors:
Peng Hao, E-mail: penghao5868@163.com
|
|
|
|
| ［1］杨秀敏，杨竹生，刘跃华. 化脓性链球菌败血症致成人暴发性紫癜一例［J］. 国际皮肤性病学杂志，2011，37(2): 123.
［2］Gupta D, Chandrashekar L, Srinivas BH, et al. Acute infectious purpura fulminans caused by group A beta-hemolytic Streptococcus: an uncommon organism［J］. Indian Dermatol Online J, 2016, 7(2): 132-133.
［3］Talwar A, Kumar S, Gopal MG, et al. Spectrum of purpura fulminans: report of three classical prototypes and review of management strategies［J］. Indian J Dermatol Venereol Leprol, 2012, 78(2): 228.
［4］Darmstadt GL. Acute infectious purpura fulminans: pathogenesis and medical management［J］. Pediatr Dermatol, 1998, 15(3): 169-183.
［5］Intan IH, Rozita AR, Norlijah O. Pneumococcal sepsis presenting as purpura fulminans in a healthy infant［J］. Ann Trop Paediatr, 2009, 29(3): 235-238.
［6］Konda S, Zell D, Milikowski C, et al. Purpura fulminans associated with Streptococcus pneumoniae septicemia in an asplenic pediatric patient［J］. Actas Dermosifiliogr, 2013, 104(7): 623-627.
［7］Hale AJ, LaSalvia M, Kirby JE, et al. Fatal purpura fulminans and Waterhouse-Friderichsen syndrome from fulminant Streptococcus pneumoniae sepsis in an asplenic young adult［J］. IDCases, 2016, 6: 1-4.
［8］Kubo K, Chishiro T, Okamoto H, et al. Purpura fulminans (symmetric peripheral gangrene): 7-year consecutive case review in Japan］［J］. Kansenshogaku Zasshi, 2009, 83(6): 639-646.
［9］Nolan J, Sinclair R. Review of management of purpura fulminans and two case reports［J］. Br J Anaesth, 2001, 86(4): 581-586.
［10］罗永刚，韩冰，段晓光，等. 急性感染性暴发性紫癜的诊断和治疗［J］. 中华急诊医学杂志， 2016， 25(3): 367-369.
［11］Childers BJ, Cobanov B. Acute infectious purpura fulminans: a 15-year retrospective review of 28 consecutive cases［J］. Am Surg, 2003, 69(1): 86-90.
［12］Albarrak M, Al-Matary A. Neonatal purpura fulminans manifestation in early-onset group B Streptococcal infection［J］. Am J Case Rep, 2013, 14: 315-317.
［13］Kravitz GR, Dries DJ, Peterson ML, et al. Purpura fulminans due to Staphylococcus aureus［J］. Clin Infect Dis, 2005, 40(7): 941-947.
［14］陈柳青，侯伟，孙建方，等. 成功治愈表皮葡萄球菌败血症致成人暴发性紫癜1例［J］. 临床皮肤科杂志， 2005， 34(6): 400-401.
［15］Konda MK, Chang S, Zaccheo M. Purpura fulminans and severe sepsis due to Pasteurella multocida infection in an immunocompetent patient［J］. BMJ Case Rep, 2016, 2016.
［16］Kato Y, Ohnishi K, Sawada Y, et al. Purpura fulminans: an unusual manifestation of severe falciparum malaria［J］. Trans R Soc Trop Med Hyg, 2007, 101(10): 1045-1047.
［17］Chalmers E, Cooper P, Forman K, et al. Purpura fulminans: recognition, diagnosis and management［J］. Arch Dis Child, 2011, 96(11): 1066-1071.
［18］Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans［J］. Plast Reconstr Surg, 2001, 107(4): 1025-1035.
［19］Roughton MC, Agarwal S, Gottlieb LJ. Surgical management of acute infectious purpura fulminans［J］. J Burn Care Res, 2011, 32(2): 231-236.
［20］Lokeshwar MR, Singhal T, Udani SV, et al. Treatment of acute infectious purpura fulminans with activated protein C［J］. Indian Pediatr, 2006, 43(6): 535-538.
［21］Okuzono S, Ishimura M, Kanno S, et al. Streptococcus pyogenes-purpura fulminans as an invasive form of group A streptococcal infection［J］. Ann Clin Microbiol Antimicrob, 2018, 17(1): 31. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
