<- Home <- Arhive <- Vol. 25, Issue 4, December 2017

Rom J Leg Med25(4)364-368(2017)
© Romanian Society of Legal Medicine

Clinical aspects and medico-legal implications of purpura fulminans in children

G. Jugulete, M. Merișescu, A. E. Bastian, M. Luminos,

Abstract: Purpura fulminans is a particular clinical entity of infectious or non-infectious etiology, which consists of an array of physio-pathological processes with rapid evolution towards intra-vascular disseminated coagulation (IDC) and multiple organ failure and death in most cases. Depending on illness evolution and timely hospital admission, death can occur in less than 24 hours, which carries medico-legal implications regarding the patient’s death.
Purpura fulminans is frequently encountered in children, predominantly in the 0-1 years age group but also in the young adult. Currently, this condition has a declining incidence due to the introduction of meningococcal and pneumococcal vaccinations.
In this paper we propose to analyze cases of pediatric purpura fulminans of infectious etiology admitted in the pediatric clinic of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”. Bucharest. In these cases, we have evaluated etiology as well as clinical evolutionary forms of purpura fulminans, as well as the timeline from admission to death.
Regarding etiology, most cases were meningococcemias; diagnosis was established on clinical criteria and confirmed through specific laboratory methods. There were situations when the patients presented themselves too late at the hospital and death took please within hours from admission. Mortality for pediatric purpura fulminans was 41.93 % out of which 76.92 % died in the first 24 hours from admission, these cases requiring necropsy because of its medico-legal implications. In all cases where a necropsy was performed, the pathology report confirmed the diagnosis of ICD with multiple-organ failure through purpura fulminans.
Infectious pediatric purpura fulminans is a severe condition with a high mortality, especially in the epidemiological conditions of Romania where vaccination coverage is low in general and pneumococcal and meningococcal vaccinations are optional.
Keywords: sepsis, mortality, child.

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