Prolonged venous hemodiafiltration and hemoperfusion with polymixin in fulminant meningococcal disease: A case report
- Authors: Serednyakov K.V.1,2, Aleksandrovich Y.S.2, Pshenisnov K.V.2, Konev A.I.1,2, Ioffe M.Y.1
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Affiliations:
- Pediatric Research and Clinical Center for Infectious Diseases under the Federal Medical Biological Agency
- Saint Petersburg State Pediatric Medical University
- Issue: Vol 13, No 4 (2023)
- Pages: 591-598
- Section: Case reports
- URL: https://journals.rcsi.science/2219-4061/article/view/249868
- DOI: https://doi.org/10.17816/psaic1567
- ID: 249868
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Abstract
Fulminate meningococcal infection is one of the most formidable life-threatening conditions in children, accompanied by a high probability of complications and adverse outcomes, including disability, irreversible damage to the central nervous system, and death. The key link in the pathogenesis of this condition is the massive release of endotoxins by the pathogen and total damage to the endothelium of all vessels, which underlies the development of septic shock and all complications. The use of extracorporeal hemocorrection methods is one of the most effective methods of treating fulminate meningococcal infection; however, despite the undoubted therapeutic effect, they are not included in the recommendations of a high level of evidence and are rarely used in routine clinical practice and, in most cases, only in the terminal phase of the disease. The study presented the characteristics of the course of generalized meningococcal infection in a 7-year-old child, including intensive care measures. Particular attention was paid to assessing the severity of the condition and the effectiveness of extracorporeal hemocorrection methods. The child’s condition upon admission to the intensive care unit was 11 points according to the pSOFA scale, which indicated the presence of decompensated multiorgan dysfunction and was the basis for prolonged venovenous hemodiafiltration. Based on the results of the endotoxin activity assay (0.67 units), hemoperfusion with polymyxin was conducted. During therapy, the patient’s condition stabilized. Sixty-eight hours after admission, medical support for hemodynamics was discontinued, and the parameters of invasive mechanical ventilation were reduced. On day 7 of treatment, the patient was extubated, and the events of respiratory distress did not increase over time. On day 8 after admission, with full compensation of all vital functions following ischemic damage and deep necrosis of the tissues of the lower extremities, the patient was transferred to a multidisciplinary surgical hospital for further treatment. Early informed use of extracorporeal hemocorrection techniques contributes to the rapid regression of septic shock events and recovery of the patient, demonstrating the high efficacy of the methods used and the need for further multicenter randomized trials to routinely use these therapies in clinical practice.
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##article.viewOnOriginalSite##About the authors
Konstantin V. Serednyakov
Pediatric Research and Clinical Center for Infectious Diseases under the Federal Medical Biological Agency; Saint Petersburg State Pediatric Medical University
Email: spbny@yahoo.com
ORCID iD: 0000-0002-2213-0477
SPIN-code: 1726-6155
MD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgYurii S. Aleksandrovich
Saint Petersburg State Pediatric Medical University
Email: Jalex1963@mail.ru
ORCID iD: 0000-0002-2131-4813
SPIN-code: 2225-1630
MD, Dr. Sci, (Med.), Professor
Russian Federation, Saint PetersburgKonstantin V. Pshenisnov
Saint Petersburg State Pediatric Medical University
Author for correspondence.
Email: Psh_K@mail.ru
ORCID iD: 0000-0003-1113-5296
SPIN-code: 8423-4294
MD, Dr. Sci. (Med.)
Russian Federation, Saint PetersburgAlexandr I. Konev
Pediatric Research and Clinical Center for Infectious Diseases under the Federal Medical Biological Agency; Saint Petersburg State Pediatric Medical University
Email: icdrkonev@yandex.ru
ORCID iD: 0000-0002-0427-7344
SPIN-code: 7458-6203
MD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgMichail Ya. Ioffe
Pediatric Research and Clinical Center for Infectious Diseases under the Federal Medical Biological Agency
Email: 1964ioffe@mail.ru
ORCID iD: 0000-0002-3366-4896
SPIN-code: 2744-2818
MD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgReferences
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