Cutaneous manifestations of fulminant sepsis by Staphylococcus aureus: An autopsy study.
Keywords:
Staphylococcus aures, skin, autopsy, septic shockAbstract
Introduction: Systemic infections by S. aureus are an important cause of hospital morbidity and mortality. Adequate clinical assessment of cutaneous manifestations could allow an opportune diagnosis of S. aureus septicemia.
Objective: To describe the cutaneous manifestations on deaths caused by S. aureus septic shock.
Materials and Methods: Prospective descriptive study of autopsy cases..
Results: Nine autopsies of patients with a clinical cause of death of S. aureus septic shock were analyzed. The cases represent the 3.1% of the total autopsies performed by the institution during that year (9/285). Mean age of the cases was 15.8 years (range, 2 to 47), seven males and two females (male/female relationship, 3.5:1). All patients adquired the infection in the community. The clinical manifestations evolved during four to six days. However, only in three cases an appropriate clinical diagnosis was made. Microbiological diagnosis of S. aureus was documented in all cases. The primary focus was the skin in seven patients and the osteoarticular system in two patients. Cutaneous macroscopic alterations included generalized pustules (5 cases), generalized petechial erythema with subcutaneous edema (2 cases), and a vesicular-pustulous varicelliform eruption (2 cases). Histologically, a septic vasculitis were found in the seven patients with generalized pustules. In the cases of generalized erythema the biopsies showed mononuclear perivascular superficial infiltrate and edema.
Conclusions: Septic shock by S. aureus is associated with multiple cutaneous manifestations which allows the identification of the disease.
Author Biographies
Julio Cesar Mantilla
Patólogo y Antropólogo Forense. Jefe del Departamento de Patología de la Universidad Industrial de Santander. Grupo de Investigación en Patología Tropical, Infecciosa y Extraordinaria. Universidad Industrial de Santander, Bucaramanga, Colombia.
Armando José Vásquez
Dermatólogo. Asesor clínico del Departamento de Patología de la Universidad Industrial de Santander. Grupo de Investigación en Patología Tropical, Infecciosa y Extraordinaria. Universidad Industrial de Santander, Bucaramanga, Colombia
Julio Alexander Díaz
Residente de tercer año en Patología. Especialista en metodología de la investigación. Grupo de Investigación en Patología Tropical, Infecciosa y Extraordinaria. Universidad Industrial de Santander, Bucaramanga, Colombia.
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