TREATMENT OF PURPURA FULMINANS IN MENINGOCOCCEMIA WITH PROTEIN-C CONCENTRATE

被引:151
作者
RIVARD, GE
DAVID, M
FARRELL, C
SCHWARZ, HP
机构
[1] UNIV MONTREAL, HOP ST JUSTINE, DEPT PEDIAT, MONTREAL, PQ H3T 1C5, CANADA
[2] IMMUNO AG WIEN, VIENNA, AUSTRIA
关键词
D O I
10.1016/S0022-3476(95)70369-1
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: To evaluate the clinical and laboratory effects of protein C concentrate as an adjunct to conventional therapy in the treatment of meningococcemia with purpura fulminans. Design: Case series (pilot study). Setting: Intensive care unit in a tertiary care pediatric hospital. Patients: Four children (aged 3 months to 15 years) requiring intensive treatment for meningococcemia with shock, disseminated intravascular coagulation, and purpura fulminans. Intervention: Intravenous administration of a protein C concentrate (100 IU/kg every 6 hours). Main outcome measures: Plasma protein C amidolytic activity, fibrinogen, and D-dimers; evolution of skin and limb lesions. Results: Treatment with protein C concentrate led to a rise in plasma protein C activity levels to within normal limits in all patients, associated with an increase in plasma fibrinogen and a bimodal decrease in D-dimers. No adverse effects were noted. All patients had reversal of organ dysfunction despite the severity of the initial illness. Two patients recovered completely with no sequelae; two required amputations. Conclusions: These encouraging clinical and laboratory results and the absence of side effects warrant the initiation of a double-blind, randomized controlled multicenter trial to determine the role of protein C replacement in the treatment of meningococcemia-associated purpura fulminans.
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页码:646 / 652
页数:7
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