streptococcal toxic shock syndrome
Introduction
Introduction to Streptococcus toxic shock syndrome Streptococcal toxicity shock syndrome (StrepTSLS) is an acute severe syndrome caused by streptococcus. It is characterized by local pain, high fever, hypotension and multiple organ involvement. It can be caused by group A streptococci and streptococci ( S. mitis) or S. viridans caused by pathogens mainly invading the human body through mucosa or skin. Most patients are infected on the basis of mild local trauma. Some patients are caused by postoperative infection, which is more common in 50 cases. Adults under the age of more common in winter and spring. basic knowledge The proportion of sickness: 0.004% - 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: necrotizing fasciitis, brain edema, coma, heart failure, disseminated intravascular coagulation
Cause
Streptococcus toxic shock syndrome etiology
(1) Causes of the disease
It can be caused by group A streptococci, S. mitis or S. viridans. The bacteria mainly invade the human body through mucosa or skin. Most patients develop infection on the basis of mild local trauma. The patient was caused by postoperative infection.
(two) pathogenesis
Most of the group A streptococci (GAS) isolated from patients with streptococcal toxic shock syndrome (TSLS) belong to the M1, M3, M6 and T3 types, all of which produce SPE (thermogenic toxin) A, B. , C, are superantigens, the study also found that the cause of multiple organ damage may be related to SPE-B (a streptococcal protease), while the M or T protein of SAg not only acts as a SAg, but also has anti-phagocytosis It can enhance the invasiveness of bacteria. In 1997, Japan reported that the pathogenesis of TSLS is related to the genetic susceptibility and antibody reactivity of GAS-infected hosts. When the host is infected by the invasive M4-type GAS strain, there is no anti-M4 in the body. Antibodies, and no pyrogenic exotoxin antibodies, clinical manifestations of angina and scarlet fever; when the invasive M1, M3, M6 type GAS enters the body, if the host has the corresponding M antibody, it will not Infection occurs; if the host has no specific M antibody, GAS can overcome the invasion of the mucosal or epithelial barrier and can cause bacteremia. When the invading strain produces SPE A, B, C, the antibody barrier is out of control or cytokine regulation. Unbalanced, typical TSLS will appear; if the host has the corresponding For pyrogenic exotoxin antibodies, only bacteremia occurs. The outcome depends on the patient's genetic characteristics, underlying disease, age, and whether or not immunosuppressive therapy is being performed. When TSLS occurs in neonates, elderly, and immunodeficient patients. Easy to cause death.
Whether the pathogenesis of TSLS caused by influenza virus (including avian influenza virus) is also related to SAg is still lacking.
Prevention
Streptococcal toxic shock syndrome prevention
prevention
Mucosa, skin soft tissue and upper respiratory tract infection should be avoided, especially local wounds and postoperative attention should be paid to the treatment of wounds; it is advisable to detect the infected lesions early and use appropriate antibiotics.
In menstruating women, to avoid the use of high-adsorption tampon, use a low-absorption tampon, and replace it 4-6 hours, and use sanitary napkins whenever possible. Wash hands before and after changing the tampon. Sanitary napkins and tampon should be placed in a dry place, not in a cool, damp bathroom. Do not put two tampon at a time, and replace the new tampon before going to bed.
The stuffing and drainage strips in the body should be replaced in time.
Avoid skin damage, and pay attention to the cleanliness of the skin and prevent infection.
The disease is dangerous and the mortality rate is high. Therefore, early detection, early diagnosis and early treatment should be done to prevent the disease from developing.
Mucosa, skin soft tissue and upper respiratory tract infection should be avoided, especially local wounds and postoperative attention should be paid to the treatment of wounds; it is advisable to detect the infected lesions early and use appropriate antibiotics.
Complication
Streptococcal toxic shock syndrome complications Complications necrotizing fasciitis cerebral edema coma heart failure disseminated intravascular coagulation
Complications include shock, DIC, renal failure, heart failure, cerebral edema, coma, etc., but 70% of patients with soft tissue infections have necrotizing fasciitis or myositis.
Symptom
Streptococci toxic shock syndrome symptoms Common symptoms Hypotension severe pain Shen Zhi soft tissue infection diarrhea myalgia peeling coma scarlet fever-like rash
Short incubation period, acute onset, a small number of patients have fever, chills, myalgia and diarrhea and other prodromal symptoms, about 85% of patients with sudden local severe pain, often limited to a certain limb, but can also be located in the chest and abdomen Similar to peritonitis, pelvic inflammatory disease, acute myocardial infarction or pericarditis, some patients have pain, but no local tenderness and other positive signs, 80% of patients have soft tissue infection, common local redness and erythema, a few develop into blisters and purple or blue Color bullae, 70% of patients with soft tissue infection develop necrotizing fasciitis or myositis; 20% of patients without soft tissue infection can have multiple clinical manifestations, such as endophthalmitis, myositis, liver Zhou Yan, peritonitis and severe sepsis, rare scarlet fever-like rash in foreign cases and peeling during recovery, generally no pharyngeal red, strawberry tongue and conjunctival hyperemia, and the above-mentioned performance is very common in domestic cases.
Almost all patients developed hypotension shock, early hypotension, and developed shock after a few hours. After using antibiotics, albumin, electrolyte solution and dopamine, about 10% of patients recovered blood pressure, and the remaining patients were still in sustained shock state. 3 days.
Renal insufficiency is the most common symptom of multiple system organ involvement, more often with shock, lasting 2 to 3 days, severe cases require dialysis treatment for 10 to 20 days, a small number of patients with renal insufficiency may appear before shock, some patients appear mental Hey, severe madness or coma, even ARDS, usually occurs after hypotension.
Examine
Examination of streptococcal toxic shock syndrome
Laboratory tests showed increased peripheral blood leukocytes, renal dysfunction and other signs of multiple system organs, local infection or blood culture found streptococcus as the basis for diagnosis.
Diagnosis
Diagnosis and identification of streptococcal toxic shock syndrome
Diagnose based on
1. There is a local skin or mucous membrane infection before the disease.
2. Acute onset, manifested as local pain, fever, hypotension and multiple system organs, some cases have scarlet fever-like rash and recovery period peeling.
3. Laboratory examination showed increased peripheral blood leukocytes, renal dysfunction and other signs of multiple system organs, local infection or blood culture found streptococcus as the basis for diagnosis.
Differential diagnosis
Note that with the toxic shock syndrome (TSS) caused by Staphylococcus aureus, the cause of TSS is mostly vaginal plug or local Staphylococcus aureus infection during menstruation, no local pain.
