Primary Meningococcal Arthritis Leading to Neisseria meningitidies Purpura Fulminans

Michel, Michael D.; Kao, Louise; Sloan, Brian K.

doi:10.5811/westjem.2012.10.12906

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…A total of 190 patients age ≥ 15 years were diagnosed with PF and underwent a surgical procedure. There were 68 case studies [1, 6, 12–25, 27, 29, 31–40, 43–45, 47–61, 63, 65–72, 74, 75, 77–87], nine case series [8, 26, 30, 41, 42, 46, 64, 73, 76], one prospective cohort [62], and one retrospective cohort [28] studies published in English. All outcomes queried were identifiable during data extraction.…”

Section: Resultsmentioning

confidence: 99%

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

et al. 2019

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Background Cutaneous manifestations of purpura fulminans (PF) present many challenges for clinicians and surgeons. In a state of septic shock complicated by limb ischemia, surgical interventions are necessary to control the pathological cascade and improve patient outcomes. The objective of this article was to report etiologies and surgical outcomes associated with cutaneous manifestations in adults. Methods This systematic review and meta-analysis compared 190 adult patients with etiologies, signs and symptoms, and surgical outcomes associated with cutaneous manifestations of PF. The PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical interventions, outcomes, and complications were recorded. Results Seventy-nine studies were eligible for the systematic review, and 77 were eligible for meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. A total of 71/190 (38%) cases reported surgical debridement. Fasciotomies were reported in 12/190 (6%) cases and 20 procedures. Amputations were reported in 154/190 (81%) cases. Reconstruction was reported in 45 cases. Skin grafts were applied in 31 cases. Flaps were used for reconstruction in 28 cases. Median (IQR) surgical procedures per patient were 4 (4, 5) procedures. Infectious organisms causing PF were 32% Neisseria meningitidis (n = 55) and 32% Streptococcus pneumonia (n = 55). Coagulase-negative Staphylococcus (95% confidence interval (CI)(8.2–177.9), p = 0.032), Haemophilus influenza (95%CI (7.2–133), p = 0.029), Streptococcus pneumonia (95% CI (13.3–75.9), p = 0.006), and West Nile Virus (95%CI (8.2–177.9), p = 0.032) were associated with significantly more extensive amputations compared to other organisms. Conclusion This systematic review and patient-level meta-analysis found the most common presentation of PF was septic shock from an infectious organism. Neisseria meningitidis and Streptococcus pneumonia were equally the most common organisms associated with PF. The majority of cases were not treated in a burn center. The most common surgeries were amputations, with below-the-knee-amputations being the most common procedure. Skin grafting was the most commonly performed reconstructive procedure. The most common complications were secondary infections. Organisms with significantly more extensive amputations were coagulase-negative Staphylococcus, Haemophilus influenza, Streptococcus pneumonia, and West Nile Virus. Interpretation of findings should be cautioned due to limited sample data.

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Section: Resultsmentioning

confidence: 99%

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

et al. 2019

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“…Only 34 cases of primary meningococcal arthritis were reported in the literature from 1980 to 2002 [12] and only sporadically thereafter. For the past 5 years, we found 8 reports of primary meningococcal arthritis in the shoulder, pelvis, sacrolic joint, knee, elbow, ankle, and polyarticular joints, and 2 cases, among those, were sterile or allergic [13][14][15][16][17][18][19][20]. To our knowledge, this is the first report of primary meningococcal arthritis in Japan.…”

Section: Discussionmentioning

confidence: 99%