Neonatal streptococcal toxic shock syndrome caused by Streptococcus dysgalactiae subsp. equisimilis

We report a neonatal infection with Streptococcus dysgalactiae subsp. equisimilis occurring through maternal transmission and presenting as streptococcal toxic shock syndrome 12 hours after birth. Pediatricians and obstetricians should be aware of the possibility of this infectious disease when examining newborns with fever. These observations suggest that antenatal maternal screening for S. dysgalactiae subsp. equisimilis should be considered.     

Pediatric streptococcal toxic shock syndrome.

Two children who presented with fever, rash, and hypotension were found to have group A beta hemolytic streptococcal toxic shock syndrome. These cases are reported to remind physicians who care for acutely ill children that exotoxin-producing streptococci can produce clinical features and multisystem failure similar to staphylococcal toxic shock syndrome.     

Staphylococcal toxic shock

The authors report the case of a 5 year-old child who, after a sore throat, developed gastrointestinal problems, high fever, scarlatinaform rash, conjunctivitis, shock with renal failure and involvement of liver, pancreas and muscles. No infectious site was detected. However, he had positive blood culture for staphylococcus aureus. The child fully recovered after a period of desquamation of the palms and soles.     

链球菌感染中毒性休克综合征

1　病史摘要女,4岁。因发烧、咳嗽6d ,加重1 5d ,气促、发绀0 5d为主诉入院。入院前6d发烧,体温38 2℃,伴声咳,同时伴头痛、阵发腹痛、食欲下降。口服利君沙、红霉素及抗感冒中药4d无好转,入院前1 5d发烧加重,体温达39～4 0℃,伴呕吐,7～8次/d ,非喷射状,呕吐物为胃内容物,躯干起红色皮疹。在我院门诊静点红霉素0 6g/d ,2d ,地塞米松2mg静注1次,无好转。入院前半天体温高达4 1℃,出现气促、发绀、呼吸困难、面色苍白、心率快,急诊入院。既往健康,生长发育正常。查体:T38 4℃,P 1 98次/min ,R70次/min ,BP 75 / 5 0mmHg ,SaO2 88%。…     

Staphylococcal toxic shock in children

Toxic shock syndrome (TSS) is reported in 2 children. TSS occurred 10 days after an accidental injury of the fore foot in one case and 5 days following surgery for severe uretero-vesical reflux in the other. The clinical illness was defined by the case definition formulated for epidemiologic studies (CDC, 1982). The diagnosis was confirmed by isolation of a Staphylococcus aureus strain producing TSST, at the infected site. Toxin-induced mediators such as interleukin I and Tumor Necrosis Factor have been incriminated in septic shock with multivisceral involvement. As in our 2 cases, the syndrome may be delayed or even absent.     

链球菌中毒性休克综合征研究进展

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Ｗｉｌｌｏｕｇｈｂｙ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(ＳＴＳＬ) ,也称链球菌中毒性休克综合征 (ＳＴＳＳ)。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 ,链球菌感染发病率激增 ,有者病情危重 ,并发症多。如 1994年美国的ＳＴＳＳ病例数达 35 0 0例 ,此外 ,日本、沙特阿拉伯等也均有较多数病例报道。但均为散发性 ,多数由局部感染所致。反之…     

Bacterial croup and toxic shock syndrome

An 8-year-old boy with bacterial tracheitis, treated by endotracheal intubation, humidification, airway toilet and antibiotics, experienced a toxic shock syndrome on the day after his admission. The course was favourable. Staphylococcus aureus was isolated from tracheal secretions. Bacterial tracheitis is an infrequent cause of non-menstrual toxic shock syndrome. The diagnosis of bacterial tracheitis should be suspected in a child with toxicity and croup who is not responding to the usual therapy. Endoscopy should be performed allowing for removal of the secretions. The maintenance of a clear airway is the main purpose of the treatment.Abbreviations TSS toxic shock syndrome - CNS central nervous system - CRP C-reactive protein - ICU intensive care unit     

链球菌中毒性休克综合征一例

患儿女 ,4岁 ,因“发热 ,咳嗽 6d ,加重伴发绀、呼吸困难2d”入院。体检 :体温 38 4℃ ,脉搏 198次 /min ,呼吸 70次 /min ,血压测不出 ,血氧饱和度 0 88。神志清 ,面色灰白 ,口唇青紫 ,全身皮肤明显花纹 ,躯干部密集猩红热样皮疹 ,鼻翼扇动 ,双肺闻及中小湿音 ,以左肺底为甚。心音尚有力 ,心率 198次 /min ,律齐 ;腹胀 ,腹肌略紧张 ,肝右肋下 2 5cm ,剑突下 3 5cm ,质地Ⅱ度 ,肠鸣音弱 ,3～ 5次 /min ,四肢凉至膝、肘部 ,远端苍白 ,脉搏触不清 ,颈抵抗可疑。辅助检查 :胸片 :左肺炎症 ;血气 :PaO2 6 3 6mmHg ,血常规WBC 9 0×10 9/L…     

儿童链球菌中毒性休克综合征

中毒性休克综合征(toxic shock syndrome,TSS)是一类起病急骤、进展迅速、以发热、皮疹、病后脱皮和脱屑、低血压、休克及多器官功能受损为特征的严重感染性疾病,有较高的死亡率。它可由多种致病菌、病毒引起,由链球菌引起的称链球菌中毒性休克综合征(streptococal toxic shock syn-drome,STSS)。引起STSS的链球菌主要是A族链球菌(group A streptococcus,GAS),B族、C族、G族和猪链球菌等引起的STSS少见。现就GAS引起的STSS的流行病学等作一综述。一、流行病学STSS主要为散发,也有在幼儿园和医院等人员集中的环境暴发的报告。…     

Maternal-fetal staphylococcal toxic shock syndrome with chorioamniotitis]

We report a rare case of mother-infant pair with Staphylococcal Toxic Shock Syndrome (TSS). A term neonate was born by caesarean section for maternal septic syndrome during per-partum. He presented with respiratory distress complicated by pulmonary hypertension, skin rash, and multiple organ system involvement. Staphylococcus aureus was isolated from placenta, surface swabs and gastric aspirate. He received adapted antibiotics, respiratory support by high frequency ventilation and NO. The mother had shock, skin rash and inflammatory syndrome. Outcome was good in both cases. The isolate produced enterotoxin C and L. Shock, exanthematous disease and multi-organ involvement complicating a staphylococcal infection in neonate must lead to suspect a TSS.     

儿童链球菌中毒性休克综合征研究进展

链球菌中毒性休克综合征是由A组β溶血性链球菌所致的急性、严重感染综合征,发病呈暴发性,以局部的疼痛、发热、低血压及多系统器官受累等为特征.它是一种由超抗原介导的疾病,儿童主要的易感因素是水痘、非甾体类抗炎药的运用及外伤等.该病病死率高,容易误诊.治疗主要是维持血流动力学的稳定和敏感抗生素的应用,静脉内免疫球蛋白可用于辅助治疗,阻断超抗原.     

Neonatal toxic shock syndrome-like exanthematous disease (NTED)

The author and colleagues recently discovered an emerging neonatal infectious disease: neonatal toxic shock syndrome-like exanthematous disease (NTED), which is induced by the superantigen toxic shock syndrome toxin-1 (TSST-1), produced by methicillin-resistant Staphylococcus aureus (MRSA). The massively expanded Vbeta2+ T cells were rapidly deleted in the peripheral blood of patients with NTED. A marked depletion of Vbeta2+ T cells was also observed in the peripheral blood before the expansion of these T cells. Anergy is specifically induced in the TSST-1 reactive T cells of patients with NTED. Rapid recovery from NTED without complications is expected to be related to the induction of immunologic tolerance in neonatal patients. Anti-TSST-1 IgG antibody of maternal origin was found to play a protective role in preventing the development of NTED. The number of hospitals that have experience caring for patients with NTED has increased threefold in the past 5 years. Most MRSA isolates from neonatal intensive care units in Japan were found to be a single clone of coagulase type II and to possess TSST-1 and staphylococcal enterotoxin C genes. The timing and increased incidence of NTED suggest the emergence of a new MRSA clone. By recognizing that TSST-1 can induce NTED, healthcare providers may give increased attention to this disease in neonatal wards.     

流行性腮腺炎并中毒性休克综合征1例

患儿 ,男 ,11岁 ,因发热 5d ,双侧腮腺大 3d ,伴烦躁、四肢湿冷 1d入院。查体 :体温 39.2℃ ,脉搏 170次 /min ,心率4 0次 /min ,血压 4 0 / 30mmHg。烦躁不安 ,全身皮肤有猩红热样皮疹。巩膜明显黄染。结膜充血。口唇黏膜干燥 ,杨梅舌 ,双侧腮腺大 ,压痛。双肺呼吸音粗 ,心率