1/34. Non-Q wave acute myocardial infarction in acute meningococcemia in a 10-year-old girl.INTRODUCTION: Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. CASE: We present the case of a 10-year-old girl with positive family history for premature myocardial infarction who sustained an acute myocardial infarction temporally related to meningococcemia. DISCUSSION: This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin i levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.- - - - - - - - - - ranking = 1keywords = intravascular (Clic here for more details about this article) |
2/34. review of management of purpura fulminans and two case reports.purpura fulminans (PF) is a haemorrhagic condition usually associated with sepsis or previous infection. Features include tissue necrosis, small vessel thrombosis and disseminated intravascular coagulation. Gram-negative organisms are the commonest cause of the acute infectious type, which is often associated with multi-organ failure. An idiopathic variety, however, is often confined to the skin. The mortality rate has decreased with better treatment of secondary infections, supportive care and new treatments, but it remains a disabling condition often requiring major amputations. We describe two cases and review the various treatments for this condition.- - - - - - - - - - ranking = 24.393019857847keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
3/34. Investigation for complement deficiency following meningococcal disease.BACKGROUND AND AIMS: The incidence of complement abnormalities in the UK is not known. It is suggested in at least three major paediatric textbooks to test for abnormalities of the complement system following meningococcal disease (MCD). methods: Over a four year period, surviving children with a diagnosis of MCD had complement activity assessed. A total of 297 children, aged 2 months to 16 years were screened. RESULTS: All children except one had disease caused by B or C serogroups. One child, with group B meningococcal septicaemia (complicated by disseminated intravascular coagulation and who required ventilation and inotropic support) was complement deficient. C2 deficiency was subsequently diagnosed. She had other major pointers towards an immunological abnormality prior to her MCD. CONCLUSION: It is unnecessary to screen all children routinely following MCD if caused by group B or C infection. However, it is important to assess the previous health of the child and to investigate appropriately if there have been previous suspicious infections, abnormal course of infective illnesses, or if this is a repeated episode of neisserial infection.- - - - - - - - - - ranking = 24.393019857847keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
4/34. Low utilisation of unactivated protein c in a patient with meningococcal septic shock and disseminated intravascular coagulation.BACKGROUND: Activated protein c has recently been shown in a multicentre trial to significantly reduce mortality in patients with septic shock. There are also some case reports and minor studies demonstrating promising results with the unactivated form of protein c. However, in children with severe meningococcal infection, skin biopsies have demonstrated low expression of endothelial thrombomodulin and protein c receptors, suggesting low protein c activation capacity in severe meningococcal sepsis. methods: A patient with meningococcal septic shock was treated with two doses of the unactivated form of protein c, the first during intense activation of the coagulation system and the second during a phase of low grade or no activation. Repeated plasma samples were analysed for protein c concentration, which made it possible to compare pharmacokinetics and half-lives of the two administrations. A shorter half-life during intense coagulation was expected if there was an activation and consumption of the protein c administered. RESULTS: The calculated half-lives of protein c during intense and low grade activation were 32 h and 19 h, respectively, a magnitude similar to that reported in protein c-deficient patients without infection. CONCLUSION: The result indicates that whole body utilisation of the unactivated protein c was low. Endothelial impairment of protein c activation does not seem to be restricted to the skin vessels only.- - - - - - - - - - ranking = 99.953250867123keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
5/34. disseminated intravascular coagulation in meningococcal sepsis. Case 7.We report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis. The article discusses new therapeutic concepts in the treatment of disseminated intravascular coagulation in meningococcal sepsis, too.- - - - - - - - - - ranking = 147.54870486495keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
6/34. Replacement treatment with protein c in an 18-year-old man with meningococcal sepsis and purpura fulminans.In separate studies on neisseria meningitidis sepsis, Powars and Fiynvandraat suggested that low protein c levels may be responsible for disseminated intravascular coagulopathy and purpura fulminans. Following on this observation, we used protein c concentrate in an 18-year-old male patient with septic shock and purpura fulminans. The patient's coagulation parameters were seriously altered: AT 45%; protein c 21%; PT 50%; platelets 55000; D-dimer 2400. Early treatment included immediate administration of 3000 IU of antithrombin and intensive therapy: antibiotic therapy, volemic replacement, supported by inotropic drugs and oxygen therapy. Given the patient's low protein c levels and the progression of purpura, replacement therapy with protein c concentrate was instituted. The initial dose of 80 IU/kg/bw (5600 IU) in bolus, was adjusted according to blood laboratory values and then set at 2000 IU every 8 hours for 4 days. An increase in protein c was observed (78%) after the 1st administration, while the D-dimer levels fell by 50%. By day 7, the patient's cardiocirculatory conditions had stabilized and the coagulation parameters had normalized; the patient was discharged from the intensive care unit. protein c replacement therapy normalized the coagulation parameters and blocked the evolution of the skin injuries.- - - - - - - - - - ranking = 4.5717571536017keywords = coagulation, intravascular (Clic here for more details about this article) |
7/34. pseudarthrosis presenting as a late complication of meningococcal septicaemia and disseminated intravascular coagulation.Late skeletal complications of meningococcal septicaemia and disseminated intravascular coagulation are well recognised in children and are largely centred on the growing epimetaphyseal region of long bones. In this article we describe a case of pseudarthrosis of the mid-ulna presenting 18 months following a devastating episode of meningococcal septicaemia in a 3-year-old boy. Radiographs and MRI demonstrated the ulna abnormality. We briefly review the late skeletal complications of the disease and other causes of pseudarthrosis.- - - - - - - - - - ranking = 121.96509928924keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
8/34. Meningococcal purpura fulminans in a patient with systemic lupus erythematosus: a mimic for catastrophic antiphospholipid antibody syndrome?purpura fulminans (PF) is a life-threatening disorder characterized by acute onset of progressive cutaneous hemorrhage, necrosis, and disseminated intravascular coagulation. Acute infectious PF occurs most commonly in the setting of meningococcal sepsis. When PF occurs in the setting of systemic lupus erythematosus (SLE), the catastrophic antiphospholipid antibody syndrome (CAPS) must be ruled out because urgent therapy is required. plasmapheresis is effective in both cases, but immunosuppression (high-dose corticosteroids plus cyclophosphamide), although beneficial in patients with CAPS, could be harmful in patients with meningococcal PF. The authors report here a patient with SLE who presented to the intensive care unit with meningococcal PF, acute renal failure, and acute respiratory distress syndrome and discuss clinical similarities and laboratory differences from CAPS.- - - - - - - - - - ranking = 24.393019857847keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
9/34. Meningococcal pericarditis and tamponade.We report the case of a 37-year-old female with a complex manifestation of serogroup C meningococcal disease. The patient presented with symptoms and signs of pneumonia, sepsis and diffuse intravascular coagulation. Moreover, she suffered from a culture-proven pyogenic pericarditis that deteriorated into cardiac tamponade. Immediate pericardiocentesis was successful and eventually the patient recovered.- - - - - - - - - - ranking = 24.393019857847keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
10/34. Severe ocular involvement in disseminated intravascular coagulation complicating meningococcaemia.BACKGROUND: disseminated intravascular coagulation (DIC) is characterized by inappropriate widespread activation of coagulation leading to extensive microvascular thrombosis and haemorrhage. Ocular involvement typically manifests as fibrin-platelet clots in the choroidal vessels of the posterior pole with overlying serous retinal detachment and sparing of the retinal vessels. methods: Case report. RESULTS: An 18-year-old female with meningococcal septicaemia and DIC developed bilateral dense vitreous haemorrhage. At vitrectomy multiple areas of sub-internal limiting membrane haemorrhage were evacuated and silicone oil injected. The patient developed bilateral large macular holes with inferior tractional retinal detachment. Two years later, final visual acuity was 6/36 OD and count fingers OS. CONCLUSION: Ocular involvement in DIC can be more extensive than choroidal vascular occlusion alone. Previous reports suggest that DIC associated with sepsis (especially meningococcaemia) may present with more severe manifestations. This may be due to sub-clinical endophthalmitis or haemorrhagic ischemia. Visual prognosis can be poor.- - - - - - - - - - ranking = 123.1556850071keywords = intravascular coagulation, coagulation, intravascular (Clic here for more details about this article) |
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