title: Current management of purpura fulminans: a multicenter study.
abstract: Seven burn centers performed a 10-yr retrospective chart review of patients diagnosed with purpura fulminans. Patient demographics, etiology, presentation, medical and surgical treatment, and outcome were reviewed. A total of 70 patients were identified. Mean patient age was 13 yr. Neisseria meningitidis was the most common etiologic agent in infants and adolescents whereas Streptococcus commonly afflicted the adult population. Acute management consisted of antibiotic administration, volume resuscitation, ventilatory and inotropic support, with occasional use of corticosteroids (38%) and protein C replacement (9%). Full-thickness skin and soft-tissue necrosis was extensive, requiring skin grafting and amputations in 90% of the patients. One fourth of the patients required amputations of all extremities. Fasciotomies when performed early appeared to limit the level of amputation in 6 of 14 patients. Therefore, fasciotomies during the initial management of these patients may reduce the depth of soft-tissue involvement and the extent of amputations.
authors.affiliation: Shriners Hospitals for Children, Cincinnati, Ohio 45229, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Warner
authors.forename: R J
authors.initials: RJ
authors.lastname: Kagan
authors.forename: K P
authors.initials: KP
authors.lastname: Yakuboff
authors.forename: N
authors.initials: N
authors.lastname: Kemalyan
authors.forename: T L
authors.initials: TL
authors.lastname: Palmieri
authors.forename: D G
authors.initials: DG
authors.lastname: Greenhalgh
authors.forename: R L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: D W
authors.initials: DW
authors.lastname: Mozingo
authors.forename: D M
authors.initials: DM
authors.lastname: Heimbach
authors.forename: N S
authors.initials: NS
authors.lastname: Gibran
authors.forename: L
authors.initials: L
authors.lastname: Engrav
authors.forename: J R
authors.initials: JR
authors.lastname: Saffle
authors.forename: L S
authors.initials: LS
authors.lastname: Edelman
authors.forename: G D
authors.initials: GD
authors.lastname: Warden
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000209:etiology / Q000628:therapy; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D019115:Fasciitis, Necrotizing / Q000209:etiology / Q000628:therapy; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology* / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008499:Medical Records; D008589:Meningococcal Infections / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology* / Q000628:therapy*; D013290:Streptococcal Infections / Q000150:complications / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States