|
脾切除术后急性感染性暴发性紫癜的治疗及文献回顾
|
Abstract:
目的:探讨脾切除后急性感染性暴发性紫癜(AIPF)的临床症状、体征及辅助检查指标等的变化,为此疾病的诊断与治疗提供参考方案。方法:回顾本科室2019年12月23日收治的1例患者的病历、临床表现、体征、实验室检查结果及诊治经过等,结合数据库中以“暴发性紫癜”与“脾切除”及“fulminant purpura”与“splenectomy”检索获得的相似病例,分析以及比较其临床特征、治疗过程以及预后,探讨可能的诊疗和防治措施。结论:肺炎链球菌导致急性感染性暴发性紫癜(AIPF)的发育免疫功能缺陷,如脾切除或者脾功能低下患者,早期识别和治疗能够改善患者预后。
Objective: To investigate the changes in the clinical symptoms, signs and auxiliary examination indicators of acute infectious fulminant purpura (AIPF) after splenectomy, and to provide a reference plan for the diagnosis and treatment of this disease. Methods: The medical records, clinical manifestations, signs, laboratory test results, diagnosis and treatment process of one patient admitted to our department on December 23, 2019 were reviewed, combined with the similar cases retrieved by “fulminant purpura” and “splenectomy” in the database, the clinical characteristics, treatment process and prognosis were analyzed and compared, and the possible diagnosis and treatment measures were discussed. Conclusion: Streptococcus pneumoniae causes acute infectious fulminant purpura (AIPF) and is good for developmental immune deficiencies, such as splenectomy or hyposplenism, and early recognition and treatment can improve the prognosis of patients.
[1] | 王本超, 金林鑫, 陈森, 等. 化脓性链球菌感染致成人急性感染性暴发性紫癜的治疗及文献回顾[J]. 中国急救医学, 2019, 39(5): 476-479. |
[2] | Edlich, R., Cross, C.L., Dahlstrom, J.J. and Long III, W.B. (2008) Modern Concepts of the Diagnosis and Treatment of Purpura Fulminans. Journal of Environmental Pathology, Toxicology and Oncology, 27, 191-196. https://doi.org/10.1615/jenvironpatholtoxicoloncol.v27.i3.30 |
[3] | 罗永刚, 韩冰, 段晓光, 等. 急性感染性暴发性紫癜的诊断和治疗[J]. 中华急诊医学杂志, 2016, 25(3): 367-369. |
[4] | Teo, H.G., Wong, J.Y. and Ting, T.L.L. (2017) Purpura Fulminans: A Rare Presentation of Streptococcus pneumoniae Infection. BMJ Case Reports, 2017, bcr-2017-221150. https://doi.org/10.1136/bcr-2017-221150 |
[5] | Perinkulam Sathyanarayanan, S., Ahmed, M. and Hericks, A. (2022) Purpura Fulminans Due to Streptococcus pneumoniae Bacteraemia in an Unsplectomised Immunocompetent Adult without Primary Hypocomplementaemia. BMJ Case Reports, 15, e249514. https://doi.org/10.1136/bcr-2022-249514 |
[6] | Walsh, L.F., Sherbuk, J.E. and Wispelwey, B. (2021) Pneumococcal Induced Thrombotic Thrombocytopenic Purpura with Features of Purpura Fulminans. BMJ Case Reports, 14, e235580. https://doi.org/10.1136/bcr-2020-235580 |
[7] | Nolan, J. and Sinclair, R. (2001) Review of Management of Purpura Fulminans and Two Case Reports. British Journal of Anaesthesia, 86, 581-586. https://doi.org/10.1093/bja/86.4.581 |
[8] | 杨秀敏, 杨竹生, 刘跃华. 化脓性链球菌败血症致成人暴发性紫癜一例[J]. 国际皮肤性病学杂志, 2011, 37(2): 123. |
[9] | Djurdjevic, N., Taweesedt, P.T., Paulson, M., LaNou, A., Radovanovic, M., Patel, J.N., et al. (2020) Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review. American Journal of Case Reports, 21, e923266. https://doi.org/10.12659/ajcr.923266 |
[10] | Chandrashekar, L., Gupta, D., Srinivas, B. and Thappa, D. (2016) Acute Infectious Purpura Fulminans Caused by Group a β-Hemolytic Streptococcus: An Uncommon Organism. Indian Dermatology Online Journal, 7, 132-133. https://doi.org/10.4103/2229-5178.178093 |
[11] | Al-Matary, A. (2013) Neonatal Purpura Fulminans Manifestation in Early-Onset Group B Streptococcal Infection. American Journal of Case Reports, 14, 315-317. https://doi.org/10.12659/ajcr.889352 |
[12] | Miao, C., Cui, Y., Yan, Z. and Jiang, Y. (2023) Pilus of Streptococcus pneumoniae: Structure, Function and Vaccine Potential. Frontiers in Cellular and Infection Microbiology, 13, Article ID: 1270848. https://doi.org/10.3389/fcimb.2023.1270848 |
[13] | Weiser, J.N., Ferreira, D.M. and Paton, J.C. (2018) Streptococcus pneumoniae: Transmission, Colonization and Invasion. Nature Reviews Microbiology, 16, 355-367. https://doi.org/10.1038/s41579-018-0001-8 |
[14] | Carpenter, C.T. and Kaiser, A.B. (1997) Purpura Fulminans in Pneumococcal Sepsis: Case Report and Review. Scandinavian Journal of Infectious Diseases, 29, 479-483. https://doi.org/10.3109/00365549709011858 |
[15] | Ward, K.M., Celebi, J.T., Gmyrek, R. and Grossman, M.E. (2002) Acute Infectious Purpura Fulminans Associated with Asplenism or Hyposplenism. Journal of the American Academy of Dermatology, 47, 493-496. https://doi.org/10.1067/mjd.2002.124701 |
[16] | Duus, S., Jespersen, S. and Wejse, C. (2024) Infectious Purpura Fulminans Associated with Pneumococcal Septicaemia in a Patient with Unacknowledged Functional Asplenia. BMJ Case Reports, 17, e251397. https://doi.org/10.1136/bcr-2022-251397 |
[17] | Hansen, K. and Singer, D.B. (2001) Asplenic-Hyposplenic Overwhelming Sepsis: Postsplenectomy Sepsis Revisited. Pediatric and Developmental Pathology, 4, 105-121. https://doi.org/10.1007/s100240010145 |
[18] | Di Sabatino, A., Carsetti, R. and Corazza, G.R. (2011) Post-Splenectomy and Hyposplenic States. The Lancet, 378, 86-97. https://doi.org/10.1016/s0140-6736(10)61493-6 |
[19] | White, C., Guarascio, A.J. and Draper, H.M. (2014) Fatal Purpura Fulminans and Septic Shock in Asplenic Patient with Streptococcus pneumoniae Bacteremia. Journal of the American Pharmacists Association, 54, 88-90. https://doi.org/10.1331/japha.2014.14505 |
[20] | Betrosian, A.P., Berlet, T. and Agarwal, B. (2006) Purpura Fulminans in Sepsis. The American Journal of the Medical Sciences, 332, 339-345. https://doi.org/10.1097/00000441-200612000-00006 |
[21] | Thomsen, R.W., Schoonen, W.M., Farkas, D.K., Riis, A., Jacobsen, J., Fryzek, J.P., et al. (2009) Risk for Hospital Contact with Infection in Patients with Splenectomy. Annals of Internal Medicine, 151, 546-555. https://doi.org/10.7326/0003-4819-151-8-200910200-00008 |
[22] | Kyaw, M.H., Holmes, E.M., Toolis, F., Wayne, B., Chalmers, J., Jones, I.G., et al. (2006) Evaluation of Severe Infection and Survival after Splenectomy. The American Journal of Medicine, 119, 276.e1-276.e7. https://doi.org/10.1016/j.amjmed.2005.07.044 |
[23] | Wojtowicz, J.M. and Jones, G.L. (2014) Streptococcus pneumoniae-Induced Purpura Fulminans in a Woman with Functional Asplenia. CJEM, 16, 339-342. https://doi.org/10.2310/8000.2013.130990 |