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Chapter 115. Approach to the Acutely Ill Infected Febrile Patient (Part 5)

Purpura Fulminans (See also Chaps. 136 and 265) Purpura fulminans is the cutaneous manifestation of DIC and presents as large ecchymotic areas and hemorrhagic bullae. Progression of petechiae to purpura, ecchymoses, and gangrene is associated with congestive heart failure, septic shock, acute renal failure, acidosis, hypoxia, hypotension, and death. Purpura fulminans has been associated primarily with N. meningitidis but, in splenectomized patients, may be associated with S. pneumoniae and H. influenzae. Several small studies have suggested that correction of the protein C deficiency evident in meningococcal purpura fulminans with drotrecogin alfa (activated) may dramatically improve outcome. . | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient Part 5 Purpura Fulminans See also Chaps. 136 and 265 Purpura fulminans is the cutaneous manifestation of DIC and presents as large ecchymotic areas and hemorrhagic bullae. Progression of petechiae to purpura ecchymoses and gangrene is associated with congestive heart failure septic shock acute renal failure acidosis hypoxia hypotension and death. Purpura fulminans has been associated primarily with N. meningitidis but in splenectomized patients may be associated with S. pneumoniae and H. influenzae. Several small studies have suggested that correction of the protein C deficiency evident in meningococcal purpura fulminans with drotrecogin alfa activated may dramatically improve outcome. Ecthyma Gangrenosum Septic shock caused by P. aeruginosa or Aeromonas hydrophila can be associated with ecthyma gangrenosum see Fig. 145-1 hemorrhagic vesicles surrounded by a rim of erythema with central necrosis and ulceration. These gramnegative bacteremias are most common among patients with neutropenia extensive burns and hypogammaglobulinemia. Other Emergent Infections Associated with Rash Vibrio vulnificus and other noncholera Vibrio bacteremic infections Chap. 149 can cause focal skin lesions and overwhelming sepsis in hosts with liver disease. After ingestion of contaminated shellfish there is a sudden onset of malaise chills fever and hypotension. The patient develops bullous or hemorrhagic skin lesions usually on the lower extremities and 75 of patients have leg pain. The mortality rate can be as high as 50-60 . Capnocytophaga canimorsus can cause septic shock in asplenic patients. Infection with this fastidious gram-negative rod typically presents after a dog bite as fever chills myalgia vomiting diarrhea dyspnea confusion and headache. Findings can include an exanthem or erythema multiforme see Fig. 52-9 cyanotic mottling or peripheral cyanosis petechiae and ecchymosis. About 30 of patients with this .