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Multicenter Study
. 2023 Apr 30;27(1):166.
doi: 10.1186/s13054-023-04461-2.

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

Damien Contou  1 , Gaëtan Béduneau  2 , Charlotte Rabault  3   4 , Romain Sonneville  3 , Antoine Marchalot  5 , Rémi Coudroy  6 , Damien Roux  7 , Martin Cour  8 , Julien Massol  9 , Sébastien Préau  10 , Nicolas de Prost  11   12 ; HOPEFUL Study Group
Collaborators, Affiliations
Multicenter Study

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

Damien Contou et al. Crit Care. .

Abstract

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.

Keywords: Diagnosis; ICU; Infectious diseases; Meningitis; Neisseria meningitidis; Purpura fulminans; Sepsis; Skin biopsy.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patients with meningococcal purpura fulminans. A skin biopsy was performed in 35% of patients (n = 68/195). The sensitivity of standard bacterial culture and meningococcal polymerase chain reaction (PCR) is displayed. *a meningococcal PCR was not performed in all eight patients with a non-contributive skin biopsy
See this image and copyright information in PMC

References

    1. Contou D, Sonneville R, Canoui-Poitrine F, Colin G, Coudroy R, Pène F, et al. Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study. Intensive Care Med. 2018;44:1502–1511. doi: 10.1007/s00134-018-5341-3. - DOI - PubMed
    1. Contou D, Canoui-Poitrine F, Coudroy R, Préau S, Cour M, Barbier F, et al. Long-term quality of life in adult patients surviving Purpura Fulminans: an exposed-unexposed multicenter cohort study. Clin Infect Dis. 2019;69:332–340. doi: 10.1093/cid/ciy901. - DOI - PubMed
    1. Contou D, Urbina T, de Prost N. Understanding purpura fulminans in adult patients. Intensive Care Med. 2022;48:106–110. doi: 10.1007/s00134-021-06580-2. - DOI - PubMed
    1. Contou D, de Prost N, HOPEFUL Study group Clinical phenotype and outcomes of pneumococcal versus meningococcal purpura fulminans: a multicenter retrospective cohort study. Crit Care. 2021;25:386. doi: 10.1186/s13054-021-03812-1. - DOI - PMC - PubMed
    1. Contou D, Sonneville R, Mekontso Dessap A, de Prost N, HOPEFUL Study group Diagnostic yield of lumbar puncture in adult patients with purpura fulminans. Intensive Care Med. 2019;45:1487–1489. doi: 10.1007/s00134-019-05676-0. - DOI - PubMed

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