Purpura fulminans due to Staphylococcus aureus

Gary R. Kravitz, David J. Dries, Marnie L Peterson, Patrick M. Schlievert

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170 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)941-947
Number of pages7
JournalClinical Infectious Diseases
Volume40
Issue number7
DOIs
StatePublished - Apr 1 2005

Bibliographical note

Funding Information:
Timothy Leonard is gratefully acknowledged for help with photographs. Financial support. US Public Health Service (research grant HL36611 [from the National Heart Lung and Blood Institute] and training grant T32-HD07381-14 [to M.L.P.]). Potential conflicts of interest. All authors: no conflicts.

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