New Deadly Disease Identified

The infection moves to the lungs, where it makes superantigens and often leads to death due to hypertension and shock.

Purpura fulminans was identified in five cases in the Minneapolis-St. Paul (MN, USA) metropolitan area during 2000-2004, and was described in the April 1, 2005, issue of Clinical Infectious Diseases. The new disease has now been determined in seven additional cases in the United States. Of all 12 known cases, only two patients have survived.

Purpura fulminans is an acute illness commonly associated with meningococcemia or invasive streptococcal disease and is typically characterized by the depletion of clotting factors in the blood and skin lesions. 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 (Minneapolis; www.med.umn.edu). "We are continuing to study and monitor cases of purpura fulminans to better understand the causes and best treatment options.”

Based on their experience, doctors at the University of Minnesota have identified three recommended treatments for purpura fulminans. One is antiobiotic therapy not only against Neisseria meningitides 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 be given an early administration of activated C (i.e., drotrecogin) to minimize purpuric skin injury and to slow the inflammatory cascade before irreparable tissue injury occurs. In addition, since toxic shock syndrome is mediated by superantigens, it is possible that intravenous immunoglobulin therapy may be indicated.

"It is important to alert medical professionals about the symptoms and treatments of this new deadly disease,” said Dr. Schlievert. He and his colleagues hypothesize that the clinical features of purpura fulminans and toxic shock syndrome seen in their patients resulted from massive cytokine release induced by the S aureus strains.