Skin biopsy in adult patients with meningococcal purpura fulminans: a multicenter retrospective cohort study
Damien Contou
,
Gaëtan Béduneau
,
Charlotte Rabault
,
Romain Sonneville
,
Antoine Marchalot
,
Rémi Coudroy
,
Damien Roux
,
Martin Cour
,
Julien Massol
,
Sébastien Préau
,
Nicolas de Prost
,
Frédéric Pène
,
Gwenhaël Colin
,
François Barbier
,
Kamel Toufik
,
Quentin Quelven
,
Guillaume Schnell
,
Stephan Ehrmann
,
Hélène Messet
,
Antoine Kimmoun
,
Pascal Beuret
,
Cédric Bruel
,
Delphine Colling
,
Alexandre Conia
,
Luis Ensenyat Martin
,
Danielle Reuter
,
Vincent Das
,
Marion Challier
,
Mathieu Jozwiak
,
Arnaud Galbois
,
Mégan Fraisse
,
Samir Jaber
,
Sébastien Jochmans
,
Pierre Kalfon
,
Marie Conrad
,
Alexandre Lautrette
,
Cédric Darreau
,
Nicolas Lerolle
,
Hugues Georges
,
Bruno Mégarbane
,
Claire Pichereau
,
Tomas Urbina
,
Eric Maury
,
Nicolas de Prost
,
Jean-Pierre Quenot
,
Bertrand Sauneuf
,
Matthieu Schmidt
,
Xavier Valette
,
Lara Zafrani
,
Daniel da Silva
,
Guillaume Rigault
,
Paul-Louis Woerther
(1)
Damien Contou
- Function : Author
- PersonId : 1188443
- ORCID : 0000-0003-4336-507X
Gaëtan Béduneau
- Function : Author
Charlotte Rabault
- Function : Author
Romain Sonneville
- Function : Author
Antoine Marchalot
- Function : Author
Rémi Coudroy
- Function : Author
Damien Roux
- Function : Author
Martin Cour
- Function : Author
Julien Massol
- Function : Author
Sébastien Préau
- Function : Author
- PersonId : 778589
- ORCID : 0000-0002-8638-7183
- IdRef : 08373810X
Nicolas de Prost
- Function : Author
- PersonId : 800657
- ORCID : 0000-0002-4833-4320
- IdRef : 06976235X
Frédéric Pène
- Function : Author
Gwenhaël Colin
- Function : Author
François Barbier
- Function : Author
Kamel Toufik
- Function : Author
Quentin Quelven
- Function : Author
Guillaume Schnell
- Function : Author
Stephan Ehrmann
- Function : Author
Hélène Messet
- Function : Author
Antoine Kimmoun
- Function : Author
Pascal Beuret
- Function : Author
Cédric Bruel
- Function : Author
- PersonId : 922814
- ORCID : 0000-0002-9923-9307
- IdRef : 081283156
Delphine Colling
- Function : Author
Alexandre Conia
- Function : Author
Luis Ensenyat Martin
- Function : Author
Danielle Reuter
- Function : Author
Vincent Das
- Function : Author
Marion Challier
- Function : Author
Mathieu Jozwiak
- Function : Author
Arnaud Galbois
- Function : Author
Mégan Fraisse
- Function : Author
Samir Jaber
- Function : Author
Sébastien Jochmans
- Function : Author
Pierre Kalfon
- Function : Author
Marie Conrad
- Function : Author
Alexandre Lautrette
- Function : Author
- PersonId : 918605
- ORCID : 0000-0003-4545-7461
- IdRef : 113365063
Cédric Darreau
- Function : Author
Nicolas Lerolle
- Function : Author
Hugues Georges
- Function : Author
Bruno Mégarbane
- Function : Author
- PersonId : 806590
- ORCID : 0000-0002-2522-2764
- IdRef : 07419190X
Claire Pichereau
- Function : Author
Tomas Urbina
- Function : Author
Eric Maury
- Function : Author
Nicolas de Prost
- Function : Author
Jean-Pierre Quenot
- Function : Author
Bertrand Sauneuf
- Function : Author
Matthieu Schmidt
- Function : Author
Xavier Valette
- Function : Author
Lara Zafrani
- Function : Author
Daniel da Silva
- Function : Author
Guillaume Rigault
- Function : Author
Abstract
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.