[Meningococcal purpura fulminans: untoward result of genetic polymorphism?].
Despite significant progress in intensive care medicine, the mortality of septic shock has not changed in recent years. Early recognition of subtle signs in favor of meningococcal sepsis, early antibiotic treatment, and aggressive hemodynamic support remains the cornerstone of therapy of severe meningococcal shock in children. Recent work has emphasized the role of genetic polymorphisms in various systems to explain the most severe cases: anti-inflammatory cytokine profile IL-10/TNF-alpha, elevated levels of plasminogen activator inhibitor type-1, variants of the gene for mannose-binding lectin complement pathway. This may explain the disillusionment of pediatric intensivists, and the general failure of immunotherapy for sepsis. Reasonable hope lies upon new meningococcal vaccines.
Mercier
J C
JC
Service de pédiatrie-réanimation, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France. jean-christophe.mercier@rdb.ap-hop-paris.fr
Bingen
E
E
Schlegel
N
N
Elion
J
J
Casanova
J L
JL
Mira
J P
JP
Beaufils
F
F
D002648:Child; D020147:Coagulation Protein Disorders / Q000150:complications; D016207:Cytokines / Q000235:genetics / Q000494:pharmacology; D020022:Genetic Predisposition to Disease; D006801:Humans; D011695:IgA Vasculitis / Q000235:genetics / Q000503:physiopathology*; D008589:Meningococcal Infections / Q000150:complications*; D011110:Polymorphism, Genetic; D012772:Shock, Septic / Q000235:genetics / Q000503:physiopathology*
D016207:Cytokines
Purpura fulminans méningococcique: rencontre malheureuse de polymorphismes génétiques?