Table 2.
Clinical course and outcomes of the 31 patients in whom TTP was initially diagnosed and plasma exchange treatment begun, and in whom the clinical abnormalities were subsequently attributed to a systemic infection. Recovery is indicated if the patient survived for more than 30 days following discontinuation of plasma exchange treatment. PEX, plasma exchange.
| No. | PEX | Clinical course following diagnosis of TTP | Infection etiology documented | Outcome (day of death) |
|---|---|---|---|---|
| 1 | 6 | PEX stopped, no response. Dx at autopsy: systemic Aspergillus fumigatus, no evidence of TTP | Aspergillus fumigatus | Died (11) |
| 2 | 1 | PEX stopped, death. Dx at autopsy: mitral valve vegetation, no bacteria seen, multi-organ infarcts, no evidence of TTP. Clinical impression, infectious endocarditis | None documented | Died (2) |
| 3 | 3 | PEX stopped, death. Clinical impression, infectious meningitis | None documented | Died (4) |
| 4 | 9 | PEX stopped, death. Rickettsia rickettsii serology + from before PEX, reported after PEX began | Rickettsia rickettsii | Died (9) |
| 5 | 11 | Blood, sputum, urine + Enterococcus faecalis day 6, assumed to be etiology of pneumonia at admission. PEX continued after Dx of infection, stopped at death | Enterococcus faecalis | Died (12) |
| 6 | 2 | PEX stopped when CMV antigen + reported, day 2 | CMV | Died (7) |
| 7 | 3 | PEX stopped, no response. Autopsy: hepatic necrosis, no evidence for TTP | Hepatitis A | Died (6) |
| 8 | 2 | PEX stopped when blood cultures from before PEX reported + for S. pyogenes | Streptococcus pyogenes | Survived |
| 9 | 2 | PEX stopped, death. Rickettsia rickettsii serology + on day 3. Dx at autopsy: myocardial necrosis, systemic vasculitis, no evidence for TTP | Rickettsia rickettsii | Died (3) |
| 10 | 2 | PEX stopped, death | Streptococcus viridans, Enterobacter aerogenes | Died (3) |
| 11 | 4 | PEX stopped, death. Cultures negative. Clinical impression, sepsis possibly related to recent cholecystitis | None documented | Died (5) |
| 12 | 7 | PEX stopped, no response. Continued treatment for HIV infection. No other infectious etiology discovered | HIV | Survived |
| 13 | 1 | PEX stopped, death. Dx at autopsy: tissue immunohistochemical and PCR + for Rickettsia rickettsii; no evidence for TTP | Rickettsia rickettsii | Died (2) |
| 14 | 2 | PEX stopped, death. | CMV | Died (3) |
| 15 | 7 | PEX stopped, death. Sputum culture + for Candida albicans PEX continued 2 days after Dx of infection | Candida albicans | Died (7) |
| 16 | 0 | Progressive respiratory failure, cultures negative. Family declined PEX. Clinical impression, bacterial pneumonia. | None documented | Died (1) |
| 17 | 18 | Blood cultures before PEX begun + for Pseudomonas and Enterococcus, reported after PEX begun, no infection source identified. PEX continued after Dx of sepsis; stopped, no response. | Pseudomonas aeruginosa, Enterococcus faecalis | Survived |
| 18 | 2 | Blood cultures before PEX begun + for S. aureus. PEX stopped when + blood cultures reported | Staphylococcus aureus | Survived |
| 19 | 14 | PEX stopped, no response. Developed skin nodules after PEX stopped, biopsy + for Blastomyces dermatitidis. | Blastomyces dermatitidis | Survived |
| 20 | 0 | Blood cultures before PEX begun + for Streptococcus pneumoniae. Died before PEX begun. | Streptococcus pneumoniae | Died (1) |
| 21 | 3 | PEX stopped, death. | Cryptococcus neoformans, Aspergillus fumigatus, Acinetobacter baumanii, Enterococcus faecalis, CMV | Died (4) |
| 22 | 3 | Blood cultures before PEX begun + for S. pneumoniae; PEX stopped when + blood cultures reported | Streptococcus pneumoniae | Survived |
| 23 | 4 | PEX stopped, death. Cultures negative. Clinical impression, bacterial pneumonia, sepsis. | None documented | Died (5) |
| 24 | 10 | PEX stopped, no response. Dx at autopsy: intracardiac thrombus around pacemaker wires infected with Aspergillus fumigatus causing pulmonary infarcts; no evidence for TTP | Aspergillus fumigatus | Died (12) |
| 25 | 19 | PEX stopped when S. pyogenes osteomyelitis Dx by shoulder surgery | Streptococcus pyogenes | Survived |
| 26 | 5 | PEX stopped, no response. | Streptococcus viridans | Died (28) |
| 27 | 12 | Blood cultures before PEX begun + for S. epidermidis; aortic valve vegetation. PEX continued after Dx of endocarditis until platelet count normal | Staphylococcus epidermidis | Survived |
| 28 | 4 | PEX stopped, no response. Cholecystitis Dx by ultrasound, surgery contraindicated, blood cultures negative. Day 4, repeat ultrasound demonstrated gangrenous gall bladder. | None documented | Died (6) |
| 29 | 4 | PEX stopped, no response. | Enterobacter cloacae | Survived |
| 30 | 1 | Died during 1st PEX. Clinical impression, Rickettsia rickettsii; serologic tests negative | None documented | Died (1) |
| 31 | 6 | PEX stopped when HIV infection diagnosed. No other etiologies for clinical features determined. | HIV | Survived |