scholarly journals Disseminated intravascular coagulation in an under-recognised zoonotic infection

2017 ◽  
Vol 16 (3) ◽  
pp. 138-141
Author(s):  
Sarah Lawrence ◽  
◽  
Andrew Claxton ◽  
Mark Holland ◽  
Jack Hodd ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Platelet Transfusion ◽  
Purpura Fulminans ◽  
Blood Cultures ◽  
Organ Support ◽  
Zoonotic Infection ◽  
Intravascular Coagulation ◽  
Prompt Treatment ◽  
History Of

A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic. Treatment is with penicillins and fluoroquinolones. Identification of risk factors for unusual organisms and recognition of DIC allowing prompt treatment is critical for the acute physician.

Severe Acquired Protein C Deficiency in Purpura Fulminans Associated With Disseminated Intravascular Coagulation: Treatment With Protein C Concentrate

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 418-422
Author(s):  
WILLIAM T. GERSON ◽  
JOSEPH D. DICKERMAN ◽  
EDWIN G. BOVILL ◽  
ELIZABETH GOLDEN
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Protein C ◽  
Purpura Fulminans ◽  
Protein S ◽  
Clinical Settings ◽  
Protein C Deficiency ◽  
Intravascular Coagulation ◽  
Hemorrhagic Necrosis ◽  
Protein C Concentrate ◽  
History Of

Purpura fulminans (PF) defines an acute, often lethal syndrome of disseminated intravascular coagulation (DIC) with rapidly progressive hemorrhagic necrosis of the skin due to dermal vascular thrombosis.1-7 It is indicative of a severe disturbance in hemostasis now recognized to involve the protein C system in many cases.1,2,5,8-12 Purpura fulminans is usually seen in three clinical settings: (1) in the newborn period as a manifestation of homozygous protein C deficiency, or rarely protein S deficiency13,14; (2) in individuals with acute, severe viral or bacterial infection where an acquired deficiency in protein C activity is documented1-3,5-8,10,12,15; and (3) as a rare, postinfectious syndrome with a history of an antecedent" preparatory disease," most commonly a viral or bacterial illness involving the skin (eg, varicella or scarlet fever), with the sudden development, during an otherwise unremarkable convalescence, of progressive purpura and necrosis.3-5,7,10,12

Purpura Fulminans in a Chinese Boy With Congenital Protein C Deficiency

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 670-676
Author(s):  
Patrick Yuen ◽  
Alfred Cheung ◽  
Hsiang Ju Lin ◽  
Faith Ho ◽  
Jun Mimuro ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Protein C ◽  
Purpura Fulminans ◽  
Fresh Frozen Plasma ◽  
Protein C Deficiency ◽  
Intravascular Coagulation ◽  
The Family ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Congenital Protein C Deficiency

Severe and recurrent purpura fulminans developed in a Chinese boy at one day of age. Results of coagulation studies performed on the patient during attacks were compatible with the diagnosis of disseminated intravascular coagulation. Subsequent investigations have revealed that the patient is homozygous and that his parents are heterozygous for protein C deficiency. Cryoprecipitate and fresh frozen plasma induced a remission, and administration of warfarin has been successful in preventing recurrence of attacks for as long as 8 months without infusion of any plasma components. None of the family members who are heterozygous for protein C deficiency have had thrombotic episodes.

scholarly journals Disseminated Intravascular Coagulation and Malignancy: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Sumit Sohal ◽  
Akhilesh Thakur ◽  
Aleena Zia ◽  
Mina Sous ◽  
Daniela Trelles
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Disseminated Intravascular Coagulation ◽  
Limb Ischemia ◽  
Symptomatic Treatment ◽  
Malignant Cells ◽  
Intravascular Coagulation ◽  
Fluid Analysis ◽  
History Of

Disseminated Intravascular Coagulation (DIC) is a disorder of coagulation which is commonly seen as a complication of infections, traumas, obstetric diseases, and cancers especially hematological and rarely solid cancers. DIC may rarely be the presenting feature of an undiagnosed malignancy. It may present in the form of different phenotypes which makes its diagnosis difficult and leads to high mortality. The treatment comprises supportive, symptomatic treatment and removal of the underlying source. Here, we present a patient with history of being on warfarin for atrial fibrillation and other comorbidities who presented with elevated INR of 6.3 and increasing dyspnea on exertion. Over the course of her stay, her platelet counts started dropping with a concurrent decrease in fibrinogen levels. She eventually developed pulmonary embolism, followed by stroke and limb ischemia, which was indicative of the thrombotic phenotype of DIC. Her pleural fluid analysis showed huge burden of malignant cells in glandular pattern suggestive of adenocarcinoma and was started on heparin drip. However, the patient had cardiac arrest and expired on the same day of diagnosis.

Role of disseminated intravascular coagulation in severe sepsis

2019 ◽  
Vol 178 ◽  
pp. 182-188 ◽  
Author(s):  
Satoshi Gando ◽  
Atsushi Shiraishi ◽  
Kazuma Yamakawa ◽  
Hiroshi Ogura ◽  
Daizoh Saitoh ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Intravascular Coagulation

scholarly journals Rat Bite Fever Resembling Rheumatoid Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ripa Akter ◽  
Paul Boland ◽  
Peter Daley ◽  
Proton Rahman ◽  
Nayef Al Ghanim
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Presentation ◽  
Blood Cultures ◽  
Zoonotic Infection ◽  
Presumptive Diagnosis ◽  
Rat Bite Fever ◽  
Rare Manifestation ◽  
History Of ◽  
High Index Of Suspicion ◽  
Culture Positive

Rat bite fever is rare in Western countries. It can be very difficult to diagnose as blood cultures are typically negative and a history of rodent exposure is often missed. Unless a high index of suspicion is maintained, the associated polyarthritis can be mistaken for rheumatoid arthritis. We report a case of culture-positive rat bite fever in a 46-year-old female presenting with fever and polyarthritis. The clinical presentation mimicked rheumatoid arthritis. Infection was complicated by discitis, a rare manifestation. We discuss the diagnosis and management of this rare zoonotic infection. We also review nine reported cases of rat bite fever, all of which had an initial presumptive diagnosis of a rheumatological disorder. Rat bite fever is a potentially curable infection but can have a lethal course if left untreated.

scholarly journals Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 8S-28S ◽  
Author(s):  
Chrysoula Papageorgiou ◽  
Georges Jourdi ◽  
Eusebe Adjambri ◽  
Amanda Walborn ◽  
Priya Patel ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Bleeding Risk ◽  
Therapeutic Strategies ◽  
Phase Iii ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
Positive Effects

Disseminated intravascular coagulation (DIC) is an acquired clinicobiological syndrome characterized by widespread activation of coagulation leading to fibrin deposition in the vasculature, organ dysfunction, consumption of clotting factors and platelets, and life-threatening hemorrhage. Disseminated intravascular coagulation is provoked by several underlying disorders (sepsis, cancer, trauma, and pregnancy complicated with eclampsia or other calamities). Treatment of the underlying disease and elimination of the trigger mechanism are the cornerstone therapeutic approaches. Therapeutic strategies specific for DIC aim to control activation of blood coagulation and bleeding risk. The clinical trials using DIC as entry criterion are limited. Large randomized, phase III clinical trials have investigated the efficacy of antithrombin (AT), activated protein C (APC), tissue factor pathway inhibitor (TFPI), and thrombomodulin (TM) in patients with sepsis, but the diagnosis of DIC was not part of the inclusion criteria. Treatment with APC reduced 28-day mortality of patients with severe sepsis, including patients retrospectively assigned to a subgroup with sepsis-associated DIC. Treatment with APC did not have any positive effects in other patient groups. The APC treatment increased the bleeding risk in patients with sepsis, which led to the withdrawal of this drug from the market. Treatment with AT failed to reduce 28-day mortality in patients with severe sepsis, but a retrospective subgroup analysis suggested possible efficacy in patients with DIC. Clinical studies with recombinant TFPI or TM have been carried out showing promising results. The efficacy and safety of other anticoagulants (ie, unfractionated heparin, low-molecular-weight heparin) or transfusion of platelet concentrates or clotting factor concentrates have not been objectively assessed.

Disseminated Intravascular Coagulation

2016 ◽  
Vol 125 (1) ◽  
pp. 230-236 ◽  
Author(s):  
Jecko Thachil
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Major Trauma ◽  
Laboratory Diagnosis ◽  
Clinical Approach ◽  
Potential Complication ◽  
Current Management ◽  
Intravascular Coagulation ◽  
Practical Guide

Abstract Anesthesiologists may encounter patients with disseminated intravascular coagulation, a potential complication of severe sepsis or major trauma. This practical guide discusses the clinical approach, laboratory diagnosis, and current management of this condition.

scholarly journals Purpura Fulminans following Thermal Injury

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Jiongyu Hu ◽  
Xupin Jiang ◽  
Ting He ◽  
Qizhi Luo
Keyword(s):  
Organ Dysfunction ◽  
Disseminated Intravascular Coagulation ◽  
Thermal Injury ◽  
Purpura Fulminans ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Small Children ◽  
Intravascular Coagulation ◽  
Intravascular Thrombosis ◽  
First Case

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin, which is an unusual cutaneous manifestation of disseminated intravascular coagulation. It often occurs in small children and babies due to infection and/or sepsis, rarely in adults in clinic. We report the first case of deadly purpura fulminans following thermal injury in a 64-year-old Chinese woman. The purpura developed sharply and aggravated multiple organ dysfunction. The patient died of purpura fulminans, disseminated intravascular coagulation, and multiple organ dysfunction syndrome.

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