Zastosowanie zaawansowanych metod terapeutycznych do leczenia wstrząsu meningokokowego — opis przypadku

BACKGROUND: Meningitis caused by Neisseria meningitidis is primarily a disease of children and young adults. If septic shock complicates the course of meningitis, it must be treated in the intensive care unit.CASE REPORT: An 18 year-old man with symptoms of meningococcal meningitis and clinical features of septic shock was admitted to the ICU. Tachycardia (heart rate 140 min-1) required vasopressor to maintain blood pressure (noradrenalin 1 μg kg-1 min-1) on admission. Respiratory failure developed (respiratory rate of 40 min-1, SaO2 79%, PaO2/FiO2 ratio = 55) and mechanical ventilatory support was used. The presence of Neisseria meningitidis was confirmed by a rapid latex agglutination test. Cefotaxime with vancomycin was administered on day one, and vancomycin was replaced by meropenem on day two. Additionally to the standard treatment of septic shock and multiorgan failure, haemoperfusion with LPS adsorber was performed to eliminate endotoxins from the bloodstream, and drotrecogin alfa was administered. Haemoperfusion was performed twice for sessions of two hours, and blood endotoxin activity decreased from 0.75 EAU to 0.4 EAU after 48 hours. The patient was admitted with signs of acute kidney injury and required continuous renal replacement therapy (Ca-Ca CVVHD, CVVHDF).CONCLUSIONS: Rapid pathogen identification, adequate antimicrobial therapy and endotoxin elimination from the bloodstream improved the haemodynamic and respiratory parameters of the patient. The application of routine plus non-standard methods of treatment of septic shock prevented the progression of the biological cascade in sepsis, and improved the patient’s clinical condition.BACKGROUND: Meningitis caused by Neisseria meningitidis is primarily a disease of children and young adults. If septic shock complicates the course of meningitis, it must be treated in the intensive care unit.CASE REPORT: An 18 year-old man with symptoms of meningococcal meningitis and clinical features of septic shock was admitted to the ICU. Tachycardia (heart rate 140 min-1) required vasopressor to maintain blood pressure (noradrenalin 1 μg kg-1 min-1) on admission. Respiratory failure developed (respiratory rate of 40 min-1, SaO2 79%, PaO2/FiO2 ratio = 55) and mechanical ventilatory support was used. The presence of Neisseria meningitidis was confirmed by a rapid latex agglutination test. Cefotaxime with vancomycin was administered on day one, and vancomycin was replaced by meropenem on day two. Additionally to the standard treatment of septic shock and multiorgan failure, haemoperfusion with LPS adsorber was performed to eliminate endotoxins from the bloodstream, and drotrecogin alfa was administered. Haemoperfusion was performed twice for sessions of two hours, and blood endotoxin activity decreased from 0.75 EAU to 0.4 EAU after 48 hours. The patient was admitted with signs of acute kidney injury and required continuous renal replacement therapy (Ca-Ca CVVHD, CVVHDF).CONCLUSIONS: Rapid pathogen identification, adequate antimicrobial therapy and endotoxin elimination from the bloodstream improved the haemodynamic and respiratory parameters of the patient. The application of routine plus non-standard methods of treatment of septic shock prevented the progression of the biological cascade in sepsis, and improved the patient’s clinical condition