Advanced therapeutic methods for the treatment of meningococcal septic shock - case report.
BACKGROUND
Meningitis caused by Neisseria meningitidis  is primarily a disease of children and young adults. If septic shock  complicates the course of meningitis, it must be treated in the  intensive care unit.


METHODS
An 18 year-old man  with symptoms of meningococcal meningitis and clinical features of  septic shock was admitted to the ICU. Tachycardia (heart rate 140 min⁻¹) required vasopressor to maintain blood pressure (noradrenalin 1 μg kg⁻¹ min⁻¹) on admission. Respiratory failure developed (respiratory rate of 40 min⁻¹, SaO₂ 79%, PaO₂/FiO₂ ratio = 55) and mechanical ventilatory support was used. The presence  of Neisseria meningitidis was confirmed by a rapid latex agglutination  test. Cefotaxime with vancomycin was administered on day one, and  vancomycin was  replaced by meropenem on day two. Additionally to the  standard treatment of septic shock and multiorgan failure,  haemoperfusion with LPS adsorber was performed to eliminate endotoxins  from the bloodstream, and drotrecogin alfa was administered.  Haemoperfusion was performed twice for sessions of two hours, and blood  endotoxin activity decreased from 0.75 EAU to 0.4 EAU after 48 hours.  The patient was admitted with signs of acute kidney injury and required  continuous renal replacement therapy (Ca-Ca CVVHD, CVVHDF).


CONCLUSIONS
Rapid pathogen identification, adequate antimicrobial therapy and  endotoxin elimination from the bloodstream improved the haemodynamic and  respiratory parameters of the patient. The application of routine plus  non-standard methods of treatment of septic shock prevented the  progression of the biological cascade in sepsis, and improved the  patient's clinical condition.
Chair and 1st Department of Anaesthesiology and Intensive Therapy, Wrocław Medical University, 50–556 Wrocław, Poland. w.duszynska@onet.eu
Wiesława
W
Duszyńska
Jakub
J
Śmiechowicz
Barbara
B
Adamik
Stanisław
S
Zieliński
Andrzej
A
Kübler
D000293:Adolescent; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008585:Meningitis, Meningococcal / Q000503:physiopathology / Q000628:therapy*; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy*