title: Meningococcal purpura fulminans treated with medicinal leeches.
abstract: BACKGROUND
  Meningococcal septicemia remains one of the most common infectious causes of admission to a pediatric intensive care unit. Numerous treatment strategies aimed at the thromboembolic complications inducing purpura fulminans and limb/digital ischemia have been attempted, with variable results. The successful use of medicinal leeches for pneumococcal purpura fulminans has been described, and we present a similar case of meningococcal purpura fulminans.
  
  
  METHODS
  A 5-wk-old female infant with meningococcal meningitis and septicemia and progressive purpura fulminans of the left hand was treated with medicinal leeches. Medicinal leeches were applied to the left dorsal hand on a daily basis for 4 consecutive days.
  
  
  RESULTS
  The swelling and limited functionality visibly improved after 48 hrs, and by 120 hrs, perfusion in the distal phalanges of the thumb and middle finger was evident. Reperfusion of the distal phalanges was not fully sustained, and at 6 wks the plastic surgery department debrided the distal phalanges of her left hand, excluding the thumb. She fully recovered from the meningococcal septicemic shock; the functionality of her left thumb was preserved, and she has limited functionality of her left hand.
  
  
  CONCLUSIONS
  The unique combination of salivary products in leech therapy has theoretical benefits and requires future study.
authors.affiliation: Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg Children's Hospital, Tygerberg, South Africa.
authors.forename: Ricky
authors.initials: R
authors.lastname: Dippenaar
authors.forename: Johan
authors.initials: J
authors.lastname: Smith
authors.forename: Pierre
authors.initials: P
authors.lastname: Goussard
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Walters
mesh_terms: D016470:Bacteremia / Q000150:complications*; D005260:Female; D005385:Fingers; D005734:Gangrene; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology* / Q000628:therapy*; D007223:Infant; D024763:Leeching; D008585:Meningitis, Meningococcal / Q000150:complications; D008589:Meningococcal Infections / Q000150:complications*