另一种类型的中毒性休克综合征

链球菌中毒性休克综合征是A型链球菌感染引起的极其严重的、进展迅速的一种表现。身体任何一部分感染病菌均可产生中毒性休克综合征,但常为软组织的感染。感染发展为低血压、休克,并累及多器官系统,造成严重的肝脏、肾脏、呼吸系统和血液系统的功能损害。链球菌型中毒性休克综合征在许多方面与人们所熟知的葡萄球菌型中毒性休克综合征很相似,其发生与在伤口填塞吸附性很强的敷料和伤口的感染有关。由链球     

重型中毒性休克综合征1例报告

中毒性休克综合征(TSS)是1种由金黄色葡萄球菌的中毒性休克综合征毒素(TSST)引起的以发热、低血压、皮疹、多器官功能损害及恢复期脱皮为特征的急性感染性疾病。国内报道尚少,我科收洽1重型TSS患者,现报告如下: 患者 男,16岁。因发热3d,神志恍惚16h于1989年3月26日入院。缘于3月23日晚开始畏寒、发热,     

小儿链球菌中毒性休克综合征

Willoughby[1] 首次报告链球菌感染可引起中毒性休克 ,并命名为链球菌中毒性休克综合征 (strep tococcaltoxicshocksyndrome ,STSS )。近年来 ,STSS因其发病率逐渐增高临床上倍受重视。本文就小儿链球菌中毒性休克综合征作以概述。1　病原学STSS的致病菌 90 %以上是A族 β -溶血性链球菌 ,国内个别报道发现α -草绿色链球菌 ,并命名为缓症链球菌 ,B组 β -溶血性链球菌罕见。目前 ,已发现A组链球菌有 15 0多个亚型 ,STSS的血清型主要为M和T亚型。常见有M 1、M 2、M 3、M 6、M 11、M 12、M 14、M 2 8、M 4 1、T1、T2、T3、T11…     

皮肤科小手术后的中毒性休克综合征

科研人员在过去10年的研究中注意到,金黄色葡萄球菌具有产生毒素的非凡能力。金葡萄球菌的许多株,包括耐甲氧西林金葡萄球菌可分泌中毒性休克综合征毒素—1(Toxic shock syndrome Toxin-1)。多达1/4的热损伤儿童可能发生中毒性休克综合征,病情的严重程度不等,从轻度临床症状到多系统衰竭和死亡。A族链球菌也能产生毒素导致中毒性休克综合征,虽然它们分泌的毒素明显不同。每年有100多名烧伤儿童被收入泰晤士东北地区烧伤医院,其中大部分患者的烧伤伤口已被金葡萄感染球菌。对照中毒性休克综合征的早期临床特点确诊后,用新鲜冷冻血浆对患者进行治疗,因为新鲜冷冻血浆含有免疫球蛋白,包括抗中毒性休克综合征毒素—1抗体。这些儿童常在输血开始后一小时之内迅速恢复。抗体常用于皮肤表面或粘     

右下肢链球菌性坏疽一例报告

链球菌性坏疽是溶血性链球菌引起的皮下组织急性化脓性炎症。病情发展快,组织坏死广泛,若处理不当,病情急剧恶化,往往并发中毒性休克而死亡。一九七八年,我们曾治愈一例,报告如下: 患者女,四十五岁。右腿痛逐渐加重一天,一九七八年十月二十五日住院。入院前一天上午,右腿膝窝胀闷不适,活动时发硬,中午就餐时胀痛,自服土霉素、     

缓症链球菌中毒性休克综合征7例

缓症链球菌中毒性休克综合征７例陈家乐（东台市人民医院，东台２２４２００）１９９０年至１９９５年的冬春季本地区出现数起类猩红热流行。现对收治的７例缓症链球菌中毒性休克综合征作一分析。１临床资料１．１病例资料７例中男５例，女２例；年龄１６～５０岁（平均２...     

16份缓症链球菌中毒性休克综合征患者血清中外毒素蛋白的测定

目的　检测缓症链球菌中毒性体克综合征患者血清中可能存在的缓症链球菌外毒素 ,探讨其与临床表现之间的关系。方法　采用ELISA竞争法 ,用亲和法纯化的兔抗缓症链球菌外毒素抗体测定患者血清中含有的缓症链球菌外毒素。结果　经过纯化的兔抗缓症链球菌外毒素抗体IgG与正常人血清反应后 ,经酶标仪读数OD均值为 0 .4 12 (± 0 .0 0 1) ,与 16份患者的血清反应后读数均小于 0 .4 12的临界值。结论　缓症链球菌中毒性休克综合征患者血清中含有缓症链球菌外毒素     

链球菌中毒性休克综合征2例报告

链球菌中毒性休克综合征(Streptococcal Toxic Shock Syndrome,STSS)是临床较少见的人畜共患传染病,但其病死率很高,现将我院2005年8月收治的2例STSS患者资料分析报告如下.     

人猪链球菌病

人猪链球菌病是人感染猪链球菌而引起的急性传染病。荚膜Ⅱ型猪链球菌是人猪链球菌病的主要病原。病、死猪为主要传染源，接触病、死猪为主要传播途径。一年四季均可发生，夏秋季多发。潜伏期多数在3d以内。临床表现为感染中毒症状、链球菌中毒性休克综合征或，和脑膜炎综合征。抗菌药物治疗有效，但疾病发展迅速，病死率高。     

链球菌中毒性休克综合征的进展

噬菌体 1群金黄色葡萄球菌中毒性休克综合征 (ＴＳＳ)已为人们所熟悉。1983年Ｗｉｌｌｉｕｇｈｂｙ报告链球菌也可引起类似综合征 ,并命名为链球菌中毒性休克样综合征 (ＳＴＳＳ) ,引起重视。近年国内外也有相应报告 ,并进行了研究 ,取得了较大进展。兹将有关文献叙述如下。1　流行病学及病原学自 2 0世纪 80年代中期以来 ,链球菌感染发病激增 ,有的病情危重 ,并发症多。如 1994年美国的ＳＴＳＳ病例数达 35 0 0例 ,日本、沙特阿拉拍等也均有较多病例数报道 ,但均为散发性 ,多数由局部感染所引起。反之 ,国内自1986年如东县、1990年江苏省…     

Necrotizing fasciitis with toxic shock-like syndrome. Case report

Fulminant group A streptococcal infection with necrotizing fasciitis and toxic shock-like syndrome is rare in Taiwan. We had diagnosed a case of necrotizing fasciitis with toxic shock-like syndrome in January, 1990. Tracing the patient's history, he was rather well in the past except that he scratched his skin occasionally. Erythromatous change with swelling and painful sensation of skin over medial aspect of left thigh was noted 4 days before admission. He called on local dermatologist and was treated with some topical medication. Unfortunately, the condition went downhill within 2 days with the lesion extending to the scrotum and causing vesicular formation and necrotic change of the skin over left thigh and scrotum. He was sent to our Emergency Room in shock condition and was admitted under impression of necrotizing fasciitis with septic shock. Incision and drainage was done in the second hospital day and group A streptococcus was isolated from blood and skin later. His condition became stable slowly. Due to extensive necrosis of skin and subcutaneous tissue, debridement had been done twice and skin graft was done one month after admission. We report this case to emphasise the rare but fulminant nature of group A streptococcal necrotizing fasciitis with toxic shock-like syndrome and the importance of early surgical and medical management.     

Toxic shock syndrome associated with diaphragm use

This article presents a case of toxic shock syndrome associated with the use of a diaphragm. The patient, a 31-year-old white female, presented with symptoms of shock and bilateral lower quadrant pain. A diagnosis of toxic shock syndrome was made on the basis of the patient's fever, rash, desquamation, and involvement of the gastrointestinal, muscular, mucous membrane, renal, and hematologic organ systems. The patient had discontinued oral contraceptive use 3 weeks earlier and had used a diaphragm for birth control the day before the onset of illness. The device was in place for 10 hours. She was not a tampon user. The diaphragm is considered to be the most likely etiologic agent in this case of toxic shock syndrome, although a specific pathophysiologic mechanism has not been identified. Caution should be exerted in prescribing the diaphragm to patients with a prior history of this syndrome.     

血立停(DY-3)的抗菌作用研究

血立停是一种直接用于出血创面的止血粉,除了其本身应无菌处理外,对该药抑茵作用的研究具有重要意义。本文着重研究该药粉对几种常见致病菌的抑菌作用,结果表明:当药物浓度在50mg/ml时对甲、乙型链球菌有抑菌作用,在100mg/ml时对白色葡萄球菌、绿脓杆菌、伤寒杆菌有抑菌作用,在200mg/ml时对大肠杆菌、结核杆菌有抑菌作用。     

The incidence of toxic shock syndrome in Northern California. 1972 through 1983

In its 1982 report on toxic shock syndrome, the institute of Medicine, Washington, DC, identified population-based studies of the incidence of toxic shock syndrome over time based on hospital records as being a high priority for further research. We conducted such a study using records of hospitalizations in Northern California Kaiser-Permanente Medical Care Program facilities for the period from 1972 through 1983 among women and men aged 15 through 34 for illnesses considered possibly to be toxic shock syndrome. Of 6,688 hospitalizations reviewed, 54 were considered definite cases of toxic shock syndrome, and an additional nine were considered probable toxic shock syndrome. Four definite cases of toxic shock syndrome occurred in men, and 50 in women. The overall incidence of definite hospitalized toxic shock syndrome in men was 0.1 per 100,000 person-years, and in women 1.5 per 100,000 person-years. In women, an increase in the incidence of toxic shock syndrome was apparent by 1977; the rate peaked in 1980, decreased slightly in 1981 and 1982, and then almost doubled again in 1983. The temporal trend in the incidence of hospitalized toxic shock syndrome in women in the years 1977 through 1982 is consistent with the best available information on patterns of use of tampons containing higher-absorbency materials. The sharp increase in the incidence of hospitalized toxic shock syndrome in 1983 remains unexplained.     

Staphylococcus aureus isolates from patients with nonmenstrual toxic shock syndrome. Evidence for additional toxins

Although toxic shock syndrome toxin-1 (TSST-1) has been proposed as the toxin responsible for toxic shock syndrome, its role in this disease has not been proved. To study this question, we examined Staphylococcus aureus strains isolated from normally sterile sites in patients with nonmenstrual toxic shock syndrome for the presence of TSST-1 production. Only 20 (62.5%) of 32 produced TSST-1, compared with 41 (93%) of 44 vaginal isolates from patients with menstrual toxic shock syndrome. Of strains of S aureus from patients with nonmenstrual toxic shock syndrome, TSST-1-negative isolates were more likely to be associated with a fatal outcome and to not be phage group 1 than TSST-1-positive isolates. Seven of the TSST-1-negative strains were evaluated in a rabbit subcutaneous chamber model of toxic shock syndrome. Fifteen (60%) of 25 rabbits developed a toxic shock syndrome-like illness and nine died. Clinical signs and histopathologic findings in the rabbits were similar to those seen in rabbits inoculated with TSST-1-positive S aureus isolates. These results suggest that other, as yet unrecognized, toxins play a role in toxic shock syndrome, and that TSST-1 production may not be essential to the pathogenesis of toxic shock syndrome.     

An Australian case of Streptococcus suis toxic shock syndrome associated with occupational exposure to animal carcasses

Streptococcus suis is known to cause sporadic infections in people who have occupational exposure to pigs and pig meat. A large outbreak occurred in China in 2005, where there was 62% mortality among those who developed toxic shock syndrome. Despite S. suis being common in pigs, this is the first published report of a human case of S. suis toxic shock syndrome in Australia.     

Scarlet fever can mimic toxic shock syndrome

We describe a patient who presented with a widespread erythematous rash, diarrhoea, confusion, pre-renal uraemia and hyponatraemia. The diagnosis of staphylococcal toxic shock syndrome seemed likely as she was menstruating and there was no evidence of pharyngitis. A rising ASO titre confirmed a streptococcal aetiology and thus 'toxic' scarlet fever. Toxic shock syndrome and toxic scarlet fever are compared.     

Toxic shock syndrome in a patient with systemic lupus erythematosus.

A case is presented of toxic shock syndrome in a patient with systemic lupus erythematosus. Toxic shock syndrome is rarely reported in patients who are immunosuppressed, perhaps because such patients are often treated vigorously with antibiotics at the earliest sign of infection. The association in this case may have been coincidental.     

Intravenous immunoglobulin therapy for toxic shock syndrome.

Staphylococcus aureus and group A Streptococcus pyogenes produce toxic shock syndrome characterized by hypotension and multisystem organ failure. While conventional therapy has consisted of antibiotics and intensive supportive care, some experimental evidence suggests that immunoglobulins directed against the toxins may be effective additional therapy. We report a case of "toxic strep syndrome" in which intravenous immunoglobulin was administered when signs and symptoms were worsening while the patient was receiving conventional therapy. Within hours of administration of the intravenous immunoglobulin, the patient experienced dramatic clinical improvement. This response suggests a possible therapeutic benefit of intravenous immunoglobulin in toxic shock syndrome.     

Toxic shock syndrome and the vaginal contraceptive sponge

Thirteen confirmed cases of toxic shock syndrome temporally related to use of the vaginal contraceptive sponge have been reported. The observed risk of toxic shock syndrome in sponge users may be elevated above estimated background rates, but this risk remains very low. Traumatic manipulation of the sponge, use during menstruation or the puerperium, and prolonged retention of the sponge may additionally increase toxic shock syndrome risk. As with all contraceptives, risks must be balanced against benefits.