Severe meningococcal shock with purpura fulminans: untoward result of genetic polymorphisms?

Despite significant progress in intensive care medicine, the mortality of s eptic shock has not changed in recent years. Early recognition of subtle si gns in favor of meningococcal sepsis, early antibiotic treatment, and aggre ssive hemodynamic support remains the cornerstone of therapy of severe meni ngococcal shock in children. Recent work has emphasized the role of genetic polymorphisms in various systems to explain the most severe cases: anti-in flammatory cytokine profile IL-10/TNF-alpha, elevated levels of plasminogen activator inhibitor type-1, variants of the gene for mannose-binding lecti n complement pathway. This may explain the disillusionment of pediatric int ensivists, and the general failure of immunotherapy for sepsis. Reasonable hope lies upon new meningococcal vaccines. (C) 2001 Editions scientifiques et medicales Elsevier SAS.