Researchers at the University of Minnesota have identified a newly emerging illness, named staphylococcal purpura fulminans. The disease begins as a respiratory tract infection, which then is infected by Staphylococcus aureus.
The infection then moves to the lungs, making superantigens (bacterial toxins that activate large numbers of T cells), often leading to death due to hypertension and shock. Purpura fulminans has been identified in five cases in the Minneapolis-St. Paul, Minn., metropolitan area during 2000-2004, as described in the April 1, 2005 issue of Clinical Infectious Diseases. This new disease has also been determined in seven additional cases nationwide. Of the 12 known cases, only two patients have survived.
Purpura fulminans is an acute illness commonly associated with meningococcemia or invasive streptococcal disease, and it is typically characterized by the depletion of clotting factors in the blood and skin lesions. Purpura fulminans refers to widespread severe purpura with extensive tissue damage and sloughing of skin. Purpura are skin lesions that may be many centimeters in diameter caused by the leakage of blood into the skin.
"It is important to alert medical professionals about the symptoms and treatments of this new deadly disease," said Patrick Schlievert, Ph.D., professor of microbiology at the University of Minnesota Medical School. "We are continuing to study and monitor cases of purpura fulminans to better understand the causes and best treatment options."
On the basis of experience, the University of Minnesota experts have identified three recommended treatments for purpura fulminans. Patients who present symptoms of purpura should receive antibiotic therapy not only against Neisseria meningitidis and streptococci, but also against methicillin-resistant S. aureus (MRSA), with the consideration that the staphylococcal disease may be more common than the two prior illnesses. Patients should also be given early administration of activated protein C (i.e., drotrecogin) in an attempt to minimize purpuric skin injury and to slow the inflammatory cascade before irreparable tissue injury occurs. In addition, because toxic shock syndrome is mediated by superantigens, it is possible that intravenous immunoglobulin therapy may be indicated. Of the five patients observed in the Minneapolis-St. Paul area during the period of 2000-2004, four of the patients were previously healthy and four of the patients were women. Schlievert and colleagues hypothesize that the clinical features of purpura fulminans and toxic shock syndrome seen in these patients resulted from massive cytokine release induced by the S. aureus strains.