Meningokoksemiye Bağlı Purpura Fulminanslı Çocuk Hastada Hiperbarik Oksijen Tedavisi

Abstract

Meningokosemi, hızla tanı konulup tedavi edilmediği takdirde purpura fulminans PF , çoklu organ yetersizliği ve ölüme neden olmaktadır. PF’a sekonder gelişen cilt lezyonlarının tedavisinde son yıllarda hiperbarik oksijen HBO2 tedavisi başarılı bir biçimde uygulanmaktadır. Bu makalede, PF sonrası gelişen cilt lezyonları HBO2 tedavisi ile belirgin düzelme gözlenen bir hasta sunulmaktadır. Vaka sunumu: Öncesinde sağlıklı 6 ay 20 günlük kız hasta, kliniğimize ateş ve saatler içinde gelişen purpurik döküntü nedeniyle getirildi. Fizik muayenede, bilinci açık ancak ajite ve septik görünümlüydü. Glasgow Koma skoru: 13; KTA, 160/dk; DSS, 42; KB,77/45 mmHg; oda havasında oksijen saturasyonu %96 ve ateşi 38.5°C timpanik idi. Laboratuvar incelemesinde anemi, beraberinde prokalsitonin ve CRP yüksekliği mevcuttu. Yoğun bakım ünitesinde izleme alınan hastaya agresif sıvı tedavisi, antibiyoterapi, hipotansif seyretmesi nedeniyle vazopresör desteği ve hidrokortizon uygulandı. Anemi, trombositopeni ve hipoalbuminemi gelişmesi nedeniyle transfüze edildi. Her iki alt ekstremite, ayak sırtında gelişen nekrotik cilt lezyonlarına HBO2 tedavisi uygulandı. Kan kültüründe Neisseria meningitidis W 135 üremesi bildirilen hastanın klinik bulguları giderek düzeldi ve yatışının 28. gününde taburcu edildi. Kraniyal manyetik rezonans görüntülemesinde kanamada regresyon izlenen hastanın cilt bulgularında belirgin iyileşme gözlendi. Sonuç: Fulminan meningokoksemide mortalite ve morbiditeyi azaltmak için erken ve uygun yaklaşım esastır. Purpura fulminans lezyonlarının tedavisinde HBO2 kuvvetle önerilmektedir

Keywords

• Meningokoksemi,purpura fulminans,hiperbarik oksijen tedavisi

Hyperbaric Oxygen Treatment for Purpura Fulminans in a Child with Meningococcemia

Abstract

Meningococcemia may lead to purpura fulminans PF , multiorgan failure and death unless prompt diagnosis, and treatment can not be achieved. In recent years hyperbaric oxygen treatment has been used. In the management of skin lesions developed secondary to PF. Herein we present a child whose skin lesions developed following onset of PF lesions which were resolved markedly with hyperbaric oxygen HBO2 therapy. Case report: AA 6- month- 20 day- old previously healthy girl presented to our clinic with fever and generalized purpuric rash which developed within hours. On her physical examination, she was conscious but septic and agitated with 38.5 °C fever tympanic . Glasgow Coma Score was 13. Heart beat, respiratory rate, blood pressure and O2 saturation at room air were noted as following: respectively, 160/min, 42/min, 77/45 mmHg, 96%. Initial blood tests showed anemia with high procalcitonin and C-reactive protein levels. She was started on aggressive hydration and antibiotherapy ceftriaxone in pediatric intensive care unit. Vasopressors and hydrocortisone were administered due to hypotension. Supportive transfusions were performed since anemia, thrombocytopenia and hypoalbuminemia had developed. HBO2 treatment was applied to necrotic lesions on her feet. Blood cultures revealed Neisseria meningitidis W 135. Her general condition improved gradually within days and she was discharged from the hospital on 28th day with recovery. A marked improvement was observed in her skin lesions, and her cranial magnetic resonance revealed regression of her bölümeeding episodes. Conclusion: Early diagnosis and appropriate intervention is crucial to decrease mortality and morbidity of fulminant meningococcemia. HBO2 treatment is highly recommended for the management of PF.

Keywords

• Meningococcemia,purpura fulminans,hyperbaric oxygen treatment

References

1. 1. Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med 2001;344:1378-88. http://dx.doi.org/10.1056/NEJM200105033441807
2. 2. Smith OP, White B. Infectious purpura fulminans: caution needed in the use of protein C. Br J Haematol 1999;106: 253-4. http://dx.doi.org/10.1046/j.1365-2141.1999.1561b.x
3. 3. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007;369:2196-210. http://dx.doi.org/10.1016/S0140-6736(07)61016-2
4. 4. Ceyhan M, Yildirim I, Balmer P, et al. A prospective study of etiology of childhood acute bacterial meningitis, Turkey. Emerg Infect Dis 2008;14:1089-96. http://dx.doi.org/10.3201/eid1407.070938
5. 5. Turner M, Kemp PM. Isotope brain scanning with Tc-HMPAO: a predictor of outcome in carbonmonoxide poisoning? J Accid Emerg Med 1997;14:139-41. http://dx.doi.org/10.1136/emj.14.3.139
6. 6. Şiraneci R, Hatipoğlu N, Hatipoğlu H, et al. Acute arterial thrombotic purpura complicating varicella and the role of hyperbaric oxygen as an adjunctive therapy. Turk J Pediatr 2004;46:256-58.
7. 7. Jain KK. Indications, contraindications and complications of hyperbaric oxygen therapy. In: Jain KK, Neubauer R, Correa JG, Camporesi EM (eds). Textbook of Hyperbaric Medicine. Seattle-Toronto-Bern-Göttingen: Hogrefe&HuberPub; 1996: 98-108.
8. 8. Brogan TV, Nizet V, Waldhausen JH, et al. Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients. Pediatr Infect Dis J 1995;14:588-94. http://dx.doi.org/10.1097/00006454-199507000-00007