Le purpura fulminans, dont l incidence annuelle est en augmentation. a une mortalite de 20-25 % et 5 a 20 % des survivants necessitent des greffes de peau et/ou des amputations. Il faut evoquer le diagnostic d infection a meningocoque en presence de tout purpura febrile, et craindre le purpura fulminans des qu il existe une ecchymose et un syndrome infectieux, en sachant que le choc est difficile a reconnaitre chez l enfant. En regroupant les malades de sept etudes, on constate que l antibiotherapie avant l admission a l hopital a un effet benefique sur la mortalite (odds ratio : 0,36 ; intervalle de confiance a 95 % : 0,23-0,56). Le Conseil superieur d hygiene publique a recemment recommande d injecter une cephalosporine de troisieme generation chez tout malade presentant des signes infectieux et un purpura necrotique ou ecchymotique (>= 3 mm). Le traitement du purpura fulminans impose le transfert en reanimation ; il repose avant tout sur l antibiotherapie, la corticotherapie, le remplissage et les catecholamines. Le traitement des necroses cutanees et des ischemies distales est difficile et encore discute. La declaration doit etre la plus rapide possible. Le meningocoque du groupe B etant en France le plus frequent, il faut esperer qu un vaccin efficace sera prochainement disponible.
Purpura fulminans, of which the incidence is increasing, has a death rate of 20-25% ; 5 to 20% of the survivors need skin grafts and/or amputations. Diagnosis of invasive meningococcal infection must be evoked in any child presenting with fever purpura; a fulminant form is to be suspected in the presence of only one ecchymosis and signs of infection, remembering that recognition of shock is difficult in children. By grouping the patients from seven studies, it can be observed that antibiotic administration prior to hospital admission has a protective effect on mortality (odds ratio : 0.36 ; 95% confidence interval : 0.23-0.56). Recently, the Health Authority has recommended to administer a third generation cephalosporin promptly for any child with signs of infection and a necrotic or ecchymotic purpura (>= 3 mm in diameter). Children with purpura fulminans should be referred to a paediatric intensive care unit. Management includes antibiotics, steroids, fluid resuscitation and catecholamines. Treatment of cutaneous necrosis and distal ischemia is difficult and still controversial. Cases must be rapidly notified. Given the predominance of serogroup B in France, we hope that an efficient vaccine will soon become available.