Purpura fulminans due to Staphylococcus aureus
Purpura fulminans due to Staphylococcus aureus
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DOI：
10.1086/428573
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发表时间：
2005-04-01
影响因子：
11.8
通讯作者：
Schlievert, PM
中科院分区：
文献类型：
--
作者：
Kravitz, GR;Dries, DJ;Schlievert, PM
背景暴发性紫癜是一种急性疾病，通常与脑膜炎双球菌血症或侵袭性链球菌病有关，其典型特征是弥散性血管内凝血（DIC）和紫癜性皮肤病变。在这篇文章中，我们报告了前5例（据我们所知）与产生高水平超抗原中毒性休克综合征毒素-1（TSST-1）、葡萄球菌肠毒素血清型B（SE B）或葡萄球菌肠毒素血清型C（SEC）的金黄色葡萄球菌菌株直接相关的暴发性紫癜。2000-2004年期间，在明尼苏达州明尼阿波利斯-圣保罗大都市地区发现了病例。S.根据培养结果诊断金黄色葡萄球菌感染，并确定对甲氧西林的敏感性。测定分离的生物体产生TSST-1、SEB、SEC和Panton-Valentine杀白细胞素（PVL）的能力。TSST-1、SEB和SEC水平也在微生物体外生长后定量。5例中有3例感染性S.从血培养物中分离出金黄色葡萄球菌菌株。5例中有2例感染性S.金黄色葡萄球菌菌株仅从呼吸道分离，表明暴发性紫癜和中毒性休克综合征是由外毒素和/或其他宿主因素引起的，而不是败血症。后2例患者中1例同时伴有坏死性肺炎，分离的沙门氏菌。金黄色葡萄球菌是产生SEC和PVL的甲氧西林抗性菌株。5例患者中仅有2例存活，其中1例接受了活化蛋白C治疗。葡萄球菌性暴发性紫癜可能是一种新出现的疾病与超抗原的生产。医生应该意识到这种疾病。
Background. Purpura fulminans is an acute illness commonly associated with meningococcemia or invasive streptococcal disease, and it is typically characterized by disseminated intravascular coagulation (DIC) and purpuric skin lesions. In this article, we report the first 5 cases (to our knowledge) of purpura fulminans directly associated with Staphylococcus aureus strains that produce high levels of the superantigens toxic shock syndrome toxin-1 (TSST-1), staphylococcal enterotoxin serotype B (SEB), or staphylococcal enterotoxin serotype C ( SEC).Methods. Cases were identified in the Minneapolis-St. Paul, Minnesota, metropolitan area during 2000-2004. S. aureus infection was diagnosed on the basis of culture results, and susceptibility to methicillin was determined. The ability of the isolated organisms to produce TSST-1, SEB, SEC, and Panton-Valentine leukocidin (PVL) was determined. TSST-1, SEB, and SEC levels were also quantified after in vitro growth of the organisms.Results. In 3 of the 5 cases, the infecting S. aureus strain was isolated from the blood cultures. In 2 of the 5 cases, the infecting S. aureus strain was isolated only from the respiratory tract, indicating that purpura fulminans and toxic shock syndrome resulted from exotoxin and/or other host factors, rather than septicemia. One of these latter 2 patients also had necrotizing pneumonia, and the isolated S. aureus was a methicillin-resistant strain that produced both SEC and PVL. Only 2 of the 5 patients survived, and 1 of the survivors received activated protein C.Conclusions. Staphylococcal purpura fulminans may be a newly emerging illness associated with superantigen production. Medical practitioners should be aware of this illness.