In France, the incidence of @entity7135 is increasing. The most severe presentation, called @entity18536 , has a death rate of 20-25%; 5 to 20% of the survivors need skin grafts and/or amputations. Diagnosis of invasive @entity7135 is very difficult when @entity4125 and "toxic" appearance are absent: one should take into account parents' impression of their ill @entity1 . This diagnosis must be evoked in any @entity1 presenting with @entity4125 (like in the United Kingdom, parents should be encouraged to use the "tumbler test" to identify a @entity1910 ); a fulminant form is to be suspected in the presence of only one ecchymosis and signs of @entity281 , remembering that recognition of shock is difficult in @entity1 . Recently, the Health Authority has recommended to administer a third generation @entity5898 promptly (before biological investigations) for any @entity1 with signs of @entity281 and a @entity39 (> 3 mm of diameter), and then to refer the @entity1 to the hospital. By grouping the @entity1 from 7 studies, it can be observed that preadmission antibiotic administration has a protective effect on mortality (odds ratio: 0.36; 95% confidence interval: 0.23-0.56); a negative effect was observed in only one of these series. @entity1 with @entity18536 should be referred to a paediatric intensive care unit. Management includes antibiotics, @entity230 , fluid resuscitation and @entity2661 (be aware of hypoglycaemia, particularly in @entity1 , and hypocalcaemia). Treatment of cutaneous @entity39 and @entity63 is difficult and still controversial: @entity5582 , @entity3790 , tissue plasminogen activator and vasodilator infusion have no proven efficacy. Cases must be rapidly notified to the Public Health Service who will institute chemoprophylaxis for close contacts. Given the predominance of serogroup B in France, we hope that an efficient vaccine will soon become available.

[Treatment of XXXX fulminans].

@entity1 :: ('9606', 'Species') :: ['Children', 'patient', 'infants', 'child', 'children', 'patients'] @entity1910 :: ('MESH:D005076', 'Disease') :: ['vasculitic rash'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis', 'necrotic or ecchymotic purpura'] @entity63 :: ('MESH:D007511', 'Disease') :: ['distal ischemia'] @entity5898 :: ('CHEBI:23066', 'Chemical') :: ['cephalosporin'] @entity18536 :: ('MESH:D055665', 'Disease') :: ['purpura fulminans'] @entity4125 :: ('MESH:D011693', 'Disease') :: ['purpura', 'febrile purpura'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity3790 :: ('5624', 'Gene') :: ['protein C'] @entity7135 :: ('MESH:D008589', 'Disease') :: ['meningococcal infection', 'meningococcal infections'] @entity230 :: ('MESH:D013256', 'Chemical') :: ['steroids'] @entity2661 :: ('MESH:D002395', 'Chemical') :: ['catecholamines'] @entity5582 :: ('462', 'Gene') :: ['antithrombin']
@entity7135 :: (MESH:D008589,Disease) :: ['meningococcal purpura']
