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Titolo:
Treatment of meningococcal purpura fulminans
Autore:
Leclerc, F; Noizet, O; Dorkenoo, A; Cremer, R; Leteurtre, S; Sadik, A; Fourier, C;
Indirizzi:
Hop Jeanne de Flandre, Serv Reanimat Pediat, F-59037 Lille, France Hop Jeanne de Flandre Lille France F-59037 Pediat, F-59037 Lille, France
Titolo Testata:
ARCHIVES DE PEDIATRIE
, volume: 8, anno: 2001, supplemento:, 4
pagine: 677S - 688S
SICI:
0929-693X(200109)8:<677S:TOMPF>2.0.ZU;2-X
Fonte:
ISI
Lingua:
FRE
Soggetto:
SEPTIC SHOCK; PLASMINOGEN-ACTIVATOR-INHIBITOR-1 GENE; ADRENAL INSUFFICIENCY; ANTIBIOTIC-TREATMENT; INFECTIOUS PURPURA; CD32 POLYMORPHISM; EARLY MANAGEMENT; PROTEIN-C; DISEASE; CHILDREN;
Keywords:
child; meningococcal infections; purpura; treatment;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
61
Recensione:
Indirizzi per estratti:
Indirizzo: Leclerc, F Hop Jeanne de Flandre, Serv Reanimat Pediat, 2 Ave Oscar Lambret, F-59037 Lille, France Hop Jeanne de Flandre 2 Ave Oscar Lambret Lille France F-59037
Citazione:
F. Leclerc et al., "Treatment of meningococcal purpura fulminans", ARCH PED, 8, 2001, pp. 677S-688S

Abstract

In France, the incidence of meningococcal infections is increasing. The most severe presentation, called purpura fulminans, has a death rate of 20-25%; 5 to 20% of the survivors need skin grafts and/or amputations. Diagnosisof invasive meningococcal infection is very difficult when purpura and "toxic" appearance are absent. one should take into account parents' impression of their ill child. This diagnosis must be evoked in any child presentingwith febrile purpura (like in the United Kingdom, parents should be encouraged to use the "tumbler test" to identify a vasculitic rash); a fulminant form is to be suspected in the presence of only one ecchymosis and signs ofinfection, remembering that recognition of shock is difficult in children. Recently, the Health Authority has recommended to administer a third generation cephalosporin promptly (before biological investigations) for any child with signs of infection and a necrotic or ecchymotic purpura (> 3 mm of diameter), and then to refer the patient to the hospital. By grouping the patients from 7 studies, it can be observed that preadmission antibiotic administration has a protective effect on mortality (odds ratio: 0.36; 95% confidence interval. 0.23-0.56); a negative effect was observed in only one ofthese series. Children with purpura fulminans should be referred to a paediatric intensive care unit. Management includes antibiotics, steroids, fluid resuscitation and catecholamines (be aware of hypoglycaemia, particularlyin infants, and hypocalcaemia). Treatment of cutaneous necrosis and distalischemia is difficult and still controversial: antithrombin, protein C, tissue plasminogen activator and vasodilator infusion have no proven efficacy. Cases must be rapidly notified to the Public Health Service who will institute chemoprophylaxis for close contacts. Given the predominance of serogroup B in France, we hope that an efficient vaccine will soon become available. (C) 2001 Editions scientitiques et medicales Elsevier SAS.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 10:31:03