Journal Article

Skin biopsy in adult patients with meningococcal purpura fulminans: a multicenter retrospective cohort study

Contou, Damien, Préau, Sébastien, Béduneau, Gaëtan, Roux, Damien, Rabault, Charlotte, Cour, Martin, Massol, Julien, Marchalot, Antoine, Sonneville, Romain, de Prost, Nicolas, Coudroy, Rémi

2023

Overview

Background Neisseria meningitidis is the leading responsible bacterium of Purpura Fulminans (PF) accounting for two thirds of PF. Skin biopsy is a simple and minimally invasive exam allowing to perform skin culture and polymerase chain reaction (PCR) to detect Neisseria meningitidis . We aimed to assess the sensitivity of skin biopsy in adult patients with meningococcal PF. Methods A 17-year multicenter retrospective cohort study including adult patients admitted to the ICU for a meningococcal PF in whom a skin biopsy with conventional and/or meningococcal PCR was performed. Results Among 306 patients admitted for PF, 195 had a meningococcal PF (64%) with a skin biopsy being performed in 68 (35%) of them. Skin biopsy was performed in median 1 day after the initiation of antibiotic therapy. Standard culture of skin biopsy was performed in 61/68 (90%) patients and grew Neisseria meningitidis in 28 (46%) of them. Neisseria meningitidis PCR on skin biopsy was performed in 51/68 (75%) patients and was positive in 50 (98%) of them. Among these 50 positive meningococcal PCR, five were performed 3 days or more after initiation of antibiotic therapy. Finally, skin biopsy was considered as contributive in 60/68 (88%) patients. Identification of the meningococcal serogroup was obtained with skin biopsy in 48/68 (71%) patients. Conclusions Skin biopsy with conventional culture and meningococcal PCR has a global sensitivity of 88% and should be systematically considered in case of suspected meningococcal PF even after the initiation of antimicrobial treatment.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Amputation / Anti-Bacterial Agents - therapeutic use / Antibiotics / Bacterial infections / Biopsy / Brief Report / Care and treatment / Cerebrospinal fluid / Cohort analysis / Critical care / Critical Care Medicine / Dermatologic agents / Dermatology / Diagnosis / Diagnostic tests / Dosage and administration / Emergency Medicine / Formulae, receipts, prescriptions / Humans / ICU / Intensive / Intensive care / Investigations / Life Sciences / Medical diagnosis / Medicine / Medicine & Public Health / Meningitis / Meningitis, Meningococcal - diagnosis / Meningitis, Meningococcal - microbiology / Meningococcal Infections - complications / Neisseria meningitidis / Patient outcomes / Polymerase chain reaction / Purpura / Purpura (Pathology) / Purpura fulminans / Purpura Fulminans - microbiology / Retrospective Studies / Sepsis / Skin / Skin biopsy