staphylococcal toxic shock syndrome
Introduction
Introduction to Staphylococcal toxic shock syndrome Staphylococcal toxicity shock syndrome (STSS) was first reported in foreign countries in 1978. In recent years, domestic reports have gradually increased. It is a disease caused by bacteriophage I group of Staphylococcus aureus, characterized by fever, syncope, hypotension, rash and multiple organ system dysfunction. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: heart failure, brain edema, coma, shock
Cause
Staphylococcal toxic shock syndrome etiology
(1) Causes of the disease
Most of the TSS-associated S. aureus are phage I group 29 or 52, and these types of S. aureus produce toxic shock syndrome toxin-1 (TSST-1).
(two) pathogenesis
Scholars have found that TSS toxin belongs to a superantigen (Supergen, SAg). This superantigen activates T cells at least 2000 times more powerful than normal antigens. SAg binds to T cell receptors (TCRs) and activates a large number of T cells. , phagocytic cells and mast cells rapidly produce interleukin-2 and 4 (IL-2, IL-4), tumor necrosis factor (TNF) -interferon and other cytokines, can induce shock, due to SAg hyperactivation, produce super-physiological The amount of cytokines plays a waterfall effect in the pathogenesis. SAg can also cause capillary leakage syndrome through the release of lymphokines and mononuclear factors. Some scholars believe that SAg can directly cause capillary leakage, TSST- 1 can directly change capillary permeability, leakage is induced by the enhancement of endotoxin shock, TSST-1 and SEA (Enterotoxin A) can enhance the lethal effect of endotoxin 105-106 times, generally within 2g Toxin injection into the human body can cause endotoxic shock, and in TSS patients, only low levels of pg and endotoxin can cause severe hypotension and shock, which is one of the so-called SAg waterfall effects.
Prevention
Staphylococcal toxic shock syndrome prevention
Use safe and reliable menstrual protection products. If there are fever, headache, vomiting and diarrhea during menstruation, it is advisable to take out the vaginal plug as soon as possible, and seek medical attention immediately. Pay attention to menstrual hygiene and try to avoid wound infection.
Complication
Staphylococcal toxic shock syndrome complications Complications heart failure cerebral edema coma shock
Complications include shock, leading to DIC, kidney failure, heart failure, cerebral edema, and coma.
Symptom
Staphylococcus toxic shock syndrome symptoms common symptoms high fever hypotension diarrhea shock syncope fatigue throat pain chills myalgia scarring
The prodromal period is 1 to 4 days, which is characterized by fever, chills, myalgia, fatigue, joint pain, headache, sore throat, vomiting, and diarrhea.
1. Skin mucosal manifestations: congestive rash, rash is diffuse, no itching, pressure fading, severe herpes, pustular rash or blemishes, conjunctiva, oropharynx and vaginal mucosa also see congestion, bayberry tongue is seen in In half of the cases, the trunk and limbs of the recovery period may have sputum-like desquamation and glove-like peeling, and no scarring.
2. Hypotension or orthostatic syncope: Shock usually occurs 72 hours after fever, and postural syncope may occur.
3. Multiple organ damage: patients with liver, heart, kidney and brain tissue damage, severe cases can be manifested as functional failure of these organs, and even respiratory distress syndrome, patients with menstruation, vaginal odor discharge, cervix Congestion, erosion, tenderness of bilateral attachments, etc.
Examine
Examination of staphylococcal toxic shock syndrome
Detection of serum TSST-1 antibody, if positive, has a certain reference value.
Diagnosis
Diagnosis and identification of staphylococcal toxic shock syndrome
Diagnostic criteria
1. Sudden high fever, body temperature above 38.9 °C.
2. Skin rash (diffuse plaque rash).
3. Skin desquamation occurs 1 to 2 weeks after onset.
4. Hypotension or orthostatic syncope.
5. At least 3 or more organs in the body are affected.
6. Blood, throat swabs and cerebrospinal fluid bacterial cultures are negative, and if the above one is missing, it is considered as a suspicious case.
Differential diagnosis
Should be associated with food poisoning, toxic scarlet fever, epidemic hemorrhagic fever, septic shock, Legionnaires' disease, leptospirosis, pediatric skin mucosal lymph node syndrome.
