title: Infectious diseases as a trigger in thrombotic microangiopathies in intensive care unit (ICU) patients?
abstract: OBJECTIVE
  Thrombotic microangiopathy (TMA) has been associated with a large number of underlying diseases. We conducted a descriptive, retrospective study including all TMA adult patients admitted to our ICU, with a particular interest in infectious episodes as a trigger of TMA.
  
  
  METHODS
  All adult patients (30) with a diagnosis of TMA admitted to the medical ICU at Saint-Louis Hospital (Paris, France) between 1992 and 1998 were retrospectively included.
  
  
  METHODS
  All patients with clinical and microbiological evidence of bacterial infection were treated with intravenous antibiotics. The specific treatment of TMA consisted in solvent/detergent-treated plasma administration by plasma exchange or high volume plasma infusion (30 ml/kg per day) in fractionated doses.
  
  
  RESULTS
  Among the 30 adult patients studied, TMA in 16 (53%) was associated with microbiologically documented infection. An acute infection was found in 8/9 patients with an HIV-related TMA, in 2/6 patients with a systemic lupus erythematosus (SLE)-related TMA and in 3/6 patients with TMA associated with other disorders. In three patients, an acute infectious disease was the only cause associated with the TMA. Four other patients had clinical manifestations suggesting an infection process but without bacteriological documentation. Escherichia coli was isolated in 7/16 cases and verotoxin was found in the stools of two other patients. All patients were treated with plasma administration and those with evidence of infection were systematically and intensively treated with antibiotics. Eventually 8 patients died (27%), 20 (67%) reached complete remission and 2 partial remission.
  
  
  CONCLUSIONS
  Bacterial infections are commonly observed amongst TMA patients hospitalized in ICUs and may act as a trigger of this disease. Screening for infection is a requirement in patients with TMA, either idiopathic or associated with other conditions.
authors.affiliation: Department of Critical Care Medicine, Hôpital Saint-Louis and University of Paris VII, 1 Rue Claude Vellefaux, 75010, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Coppo
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Leleu
authors.forename: Eric
authors.initials: E
authors.lastname: Oksenhendler
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.forename: Jean Roger
authors.initials: JR
authors.lastname: Le Gall
authors.forename: Annette
authors.initials: A
authors.lastname: Bussel
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D011697:Purpura, Thrombotic Thrombocytopenic / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents