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Purpura fulminans due to Staphylococcus aureus
Journal article   Open access   Peer reviewed

Purpura fulminans due to Staphylococcus aureus

Gary R Kravitz, David J Dries, Marnie L Peterson and Patrick M Schlievert
Clinical infectious diseases, Vol.40(7), pp.941-947
04/01/2005
DOI: 10.1086/428573
PMID: 15824983
url
https://doi.org/10.1086/428573View
Published (Version of record) Open Access

Abstract

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). 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. 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. Staphylococcal purpura fulminans may be a newly emerging illness associated with superantigen production. Medical practitioners should be aware of this illness.
 Shock, Septic - pathology Staphylococcal Infections - drug therapy Shock, Septic - etiology Staphylococcus aureus - isolation & purification Staphylococcal Infections - pathology Humans Middle Aged Purpura, Schoenlein-Henoch - pathology Male Sepsis - complications Purpura, Schoenlein-Henoch - etiology Staphylococcal Infections - complications Leukocidins Exotoxins - metabolism Superantigens - metabolism Anti-Bacterial Agents - therapeutic use Bacterial Toxins - metabolism Enterotoxins - metabolism Adult Female Staphylococcal Infections - microbiology Sepsis - microbiology Purpura, Schoenlein-Henoch - microbiology Staphylococcus aureus - metabolism

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