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Prognostic factors of severe infectious purpura in children

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The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p<0.001), coma (p<0.05), ecchymotic or necrotic purpura (p<0.01), temperature <36°C (p<0.05), no clinical meningism (p<0.001), white cell count <10,000/mm3 (p<0.05), thrombocytopenia <100,000 (p<0.01), fibrinogen <1.5 g/l (p<0.001), kalemia >5 mEq/l (p<0.01), spinal fluid cell count <20/mm3 (p<0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.

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  1. 1.

    Andersen BM (1978) Mortality in meningococcal infections. Scand J Infect Dis 10:277

  2. 2.

    Aujard Y, Azancot A, Aufrant C, Bompart Y, Beaufils F, Mathieu H (1980) Explorations hémodynamiques et échocardiographiques des méningococcies graves de l'enfant. Arch Fr Pediatr 37:507

  3. 3.

    Aujard Y, Gaudelus J (1979) Amélioration du pronostic des méningococcies graves de l'enfant par la prise en compte de l'incompétence myocardique. In: Journées Parisiennes de Pédiatrie. Flammarion, Paris, pp 131

  4. 4.

    Beal G, Mozziconacci P (1973) Méningococcémie fulminante de l'enfant. Ann Pediatr 20:393

  5. 5.

    Benzecri JP (1976) L'analyse des données. L'analyse des correspondances. Dunod, Paris

  6. 6.

    Berkowitz FE, Vallabh P, Altman DI, Diamentes F, Van Wyck HJP, Stroucken JMM (1983) Jarisch-Herxheimer reaction in meningococcal meningitis. Am J Dis Child 137:599

  7. 7.

    Brivet F, Delfraissy JF, Huault G, Dormont J (1981) Purpuras infectieux sévères. Rev Prat 31:743

  8. 8.

    Conner WT, Minielly JA (1980) Cerebral oedema in fatal meningococcemia. Lancet 2:967

  9. 9.

    Edwards MS, Baker CJ (1981) Complications and sequelae of meningococcal infections in children. J Pediatr 99:540

  10. 10.

    Hardaway RM (1981) Prediction of survival or death of patients in a state of severe shock. Surg Gynecol Obstet 152:200

  11. 11.

    Hellgren M, Egberg N, Eklund J (1984) Blood coagulation and fibrinolytic factors and their inhibitors in critically ill patients. Intensive Care Med 10:23

  12. 12.

    Jacobs RF, Hsi S, Wilson CB, Benjamin D, Smith AL, Morrow R (1983) Apparent meningococcemia: clinical features of disease due to haemophilus influenzae and neisseria meningitidis. Pediatrics 72:469

  13. 13.

    Kahn A, Blum D (1978) Factors for poor prognosis in fulminating meningococcemia. Conclusions from observations of 67 childhood cases. Clin Pediatr 17:680

  14. 14.

    Leroy J, Lamagnere JP, Mercier C, Fauchier CI, Leroux ME, Laugier J (1974) La coagulopathie consommation au cours des purpuras fulminans et son traitement (10 observations). Ann Pediatr 50:843

  15. 15.

    Lewis LS (1979) Prognostic factors in acute meningococcemia. Arch Dis Child 54:44

  16. 16.

    Mauger DC (1971) Hypokalemia as a consistent feature of fulminant meningococcal septicaemia. Aust Paediatr J 7:84

  17. 17.

    Niklasson PM, Lundbergh P, Strandell T (1971) Prognostic factors in meningococcal disease. Scand J Infect Dis 3:17

  18. 18.

    Ravussin JJ, Freycon F, Sassolas F, Teyssier G, Lauras B, Lepetit JC (1979) Méningococcies fulminantes de l'enfant. A propos de 17 observations. Pédiatrie 34:621

  19. 19.

    Saint Martin J, Lebouar Y, Huault G, Cloup M, Kachaner J, Joly JB, Beaufils F (1972) Les formes fulminantes des méningococcies de l'enfant. Arch Fr Pediatr 29:469

  20. 20.

    Shneerson JM, Fawcett IW (1979) The complications and management of meningococcal meningitis. Intensive Care Med 5:5

  21. 21.

    Stiehm ER, Damrosch DS (1966) Factors in the prognosis of meningococcal infection. J Pediatz 68:457

  22. 22.

    Toews WH, Bass JW (1974) Skin manifestations of meningococcal infection. An immediate indicator of prognosis. Am J Dis Child 127:173

  23. 23.

    Tubbs HR (1980) Endotoxin in meningococcal infections. Arch Dis Child 55:808

  24. 24.

    Vik-mo H, Lote K, Nordoy A (1978) Disseminated intravascular coagulation in patients with meningococcal infection: laboratory diagnosis and prognostic factors. Scand J Infect Dis 10:187

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90 cases from the Collaborative Study of the French Club of Pediatric Intensive Care

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Leclerc, F., Beuscart, R., Guillois, B. et al. Prognostic factors of severe infectious purpura in children. Intensive Care Med 11, 140–143 (1985). https://doi.org/10.1007/BF00258539

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Key words

  • Infectious purpura
  • Fulminating meningococcemia
  • Prognostic score