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Streptococcal Toxic-Shock Syndrome

STSS


Presentation

  • In this case report, we present a 5-year-old child who presented with a septic arthritis of the knee, whose final diagnosis was streptococcal toxic shock syndrome.[ncbi.nlm.nih.gov]
  • We present the first known case of STSS associated with a reconstructive procedure.[ncbi.nlm.nih.gov]
  • Her clinical presentation and laboratory findings meet the Centers for Disease Control and Prevention diagnostic criteria for streptococcal toxic shock syndrome. Her diagnosis was confirmed by autopsy.[ncbi.nlm.nih.gov]
  • The presentation, pathophysiology, and management of invasive group A streptococcus and streptococcal toxic shock syndrome are reviewed.[ncbi.nlm.nih.gov]
  • Here, we present a case of bullous impetigo in an infant with streptococcal toxic shock syndrome. This is a rare presentation of bullous impetigo caused by group A streptococcus.[ncbi.nlm.nih.gov]
Fever
  • The child developed a multi-organ failure with persistent hematuria, persistent fever, ascites, pericardial and pleural effusions. Intensive microbial and viral analysis did not result in any relevant finding.[ncbi.nlm.nih.gov]
  • Streptococcal toxic shock syndrome should be considered in paediatric patients with fever, vomiting, diarrhoea, abdominal pain and early shock.[ncbi.nlm.nih.gov]
  • STSS mostly develops after extremity pain, but initial influenza-like symptoms of fever, chill, myalgia and gastrointestinal symptoms may also occur.[ncbi.nlm.nih.gov]
  • GAS TSS should be considered in the differential diagnosis of pregnant patients presenting with fever and rapid onset of septic shock.[ncbi.nlm.nih.gov]
  • A 31-year-old woman, para 4, developed fever, abdominal pain, nausea and vomiting two days after insertion of a CuT380A copper IUD. Six days after insertion the patient fulfilled the criteria for TSS.[ncbi.nlm.nih.gov]
Constitutional Symptom
  • All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection.[ncbi.nlm.nih.gov]
Inguinal Hernia
  • In patient 1 the syndrome was associated with the development of necrotizing fasciitis following inguinal hernia repair. Patient 2 suffered from StrepTSS shortly after receiving a tetanus vaccine in her left deltoid.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Streptococcal toxic shock syndrome should be considered in paediatric patients with fever, vomiting, diarrhoea, abdominal pain and early shock.[ncbi.nlm.nih.gov]
  • Streptococcal toxic shock syndrome with the initial manifestation of abdominal pain and cholecystitis is rare. We report the case of a 10-year-old boy who presented with abdominal pain, cholecystitis and shock initially.[ncbi.nlm.nih.gov]
  • A 43-year-old woman presented with fevers, vaginal bleeding and abdominal pain after an office endometrial biopsy. She was found to have sepsis, shock abdominal tenderness and an erythematous rash.[ncbi.nlm.nih.gov]
  • A previously healthy 10-year-old boy presented with abdominal pain, vomiting, diarrhoea and fever for 3 days. He was admitted with signs of an acute abdomen. A treatment with ibuprofen had been started before admission.[ncbi.nlm.nih.gov]
  • TP therapy is used to treat many cancers, including gynecological cancer, but may cause adverse reactions of neuropathy and nephrotoxicity and sometimes fever, arthralgia, myalgia, abdominal pain and general malaise.[ncbi.nlm.nih.gov]
Abdominal Tenderness
  • She was found to have sepsis, shock abdominal tenderness and an erythematous rash. She was managed with intravenous antibiotics and fluid resuscitation.[ncbi.nlm.nih.gov]
  • All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection.[ncbi.nlm.nih.gov]
Exudative Pharyngitis
  • CASE: A 28-year-old man drove to our ED with exudative pharyngitis. A rapid streptococcal test was positive. While awaiting oral penicillin he became hypotensive refractory to IV fluids and developed knee effusion.[ncbi.nlm.nih.gov]
Hypotension
  • Two children who presented with fever, rash, and hypotension were found to have group A beta hemolytic streptococcal toxic shock syndrome.[ncbi.nlm.nih.gov]
  • The patient presented with hypotension, coagulation defects, adult respiratory distress syndrome and scarlet exanthema as a complication of hemolytic group A streptococcal endometritis.[ncbi.nlm.nih.gov]
  • The first patient was a 45-year-old male who developed necrotizing fasciitis and myositis of the left thigh, refractory hypotension, hepatic dysfunction and acute renal failure; the patient died despite treatment.[ncbi.nlm.nih.gov]
  • To establish the presence of STSS, hypotension and multiorgan failure must accompany evidence of Streptococcal pyogenes infection. We report a case of STSS in a 61 year old diabetic man.[ncbi.nlm.nih.gov]
  • He quickly developed coagulation disturbances, hypotension and renal function impairment. Despite broad-spectrum antibiotic therapy, he deteriorated.[ncbi.nlm.nih.gov]
Tachycardia
  • All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection.[ncbi.nlm.nih.gov]
  • […] staphylococcus (tampon, swab, infected skin lesion, respiratory tract, post partum, osteomyelitis) systemic symptoms (fever, chills, rigors) myalgia GI upset – vomiting and diarrhoea headache sore throat shock with multi-organ failure EXAMINATION fever tachycardia[lifeinthefastlane.com]
  • This cytokine storm is thought to drive the rapid onset of hypotension, fever, tachycardia, and multiorgan failure so characteristic of the toxic shock syndromes.[infectiousdiseaseadvisor.com]
Ulcer
  • In the first case the debridement was incomplete, which resulted in an extensive ulceration. Wary of repeating this experience, we made an early diagnosis and did a thorough debridement in the second case.[ncbi.nlm.nih.gov]
  • A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected.[jstage.jst.go.jp]
Palpable Purpura
  • Palpable purpura resulting from cocaine and levamisole coingestion has been reported with increasing frequency over the last several years as distribution of this drug combination becomes more universal.[ncbi.nlm.nih.gov]
Knee Effusion
  • While awaiting oral penicillin he became hypotensive refractory to IV fluids and developed knee effusion. The patient noted progressive dimming of his vision. Arthrocentesis yielded GAS.[ncbi.nlm.nih.gov]
Leg Pain
  • Several hours after admission, leg pain and purpura-like skin color appeared.[ncbi.nlm.nih.gov]
Musculoskeletal Pain
  • Streptococcal toxic shock syndrome often presents with complaints of musculoskeletal pain, which frequently leads to early involvement of an orthopaedic surgeon.[ncbi.nlm.nih.gov]
Oliguria
  • Despite improved circulation over the next 2 days, he developed oliguria, progressive fluid overload, generalised oedema and a right-sided pleural effusion. Dialysis was commenced on day 3 of admission.[ncbi.nlm.nih.gov]
Vaginal Bleeding
  • A 43-year-old woman presented with fevers, vaginal bleeding and abdominal pain after an office endometrial biopsy. She was found to have sepsis, shock abdominal tenderness and an erythematous rash.[ncbi.nlm.nih.gov]

Treatment

  • After an intensive-care treatment of 4 weeks according to international critical-care guidelines the child could be discharged without residuals.[ncbi.nlm.nih.gov]
  • Treatment is primarily surgical debridement of infected tissue with supportive care, antibiotics, and hemodynamic monitoring.[ncbi.nlm.nih.gov]
  • GAS vaginitis warrants appropriate treatment as it may progress to severe systemic infection as described.[ncbi.nlm.nih.gov]
  • Nonetheless, IVIG may serve as a useful adjunct therapy for patients suffering from severe complicated CDI (shock, ileus, or megacolon) who do not respond to conventional treatment.[ncbi.nlm.nih.gov]
  • Intravenous immunoglobulin (IVIG) therapy has been suggested as adjunctive treatment with a beneficial effect on mortality. However the clinical evidence is limited.[ncbi.nlm.nih.gov]

Prognosis

  • Early diagnosis with effective treatment can yield a good prognosis; development of organ damage usually worsens the patient's prognosis.[medicinenet.com]
  • The remaining 40% are menstrual related and have a better prognosis.[errolozdalga.com]
  • Prognosis The prognosis is variable. Many people recover completely while others may die even with prompt treatment in the hospital.[drugs.com]
  • Activated protein C was therefore withdrawn in 2011. [ 13 ] Prognosis Mortality rate for TSS is around 5-15%. A fatality rate of up to 64% has been noted in cases of STSS in the UK. [ 3 ] Recurrence of TSS is found in 30-40% of cases.[patient.info]
  • Prognosis [ edit ] With proper treatment, people usually recover in two to three weeks. [ citation needed ] The condition can, however, be fatal within hours.[en.wikipedia.org]

Etiology

  • This small series supports recognition of group G Streptococcus in the etiology of STSS. We propose intravenous immunoglobulin be used in treatment as it is for STSS caused by group A Streptococcus.[ncbi.nlm.nih.gov]
  • Very recently, SS2 has been recognized as an etiological agent for streptococcal toxic shock syndrome (STSS), which was originally associated with Streptococcus pyogenes (GAS) in Streptococci.[ncbi.nlm.nih.gov]
  • […] of diseases in human communities. 2. the field of medicine concerned with the determination of the specific causes of localized outbreaks of infection, such as hepatitis, of toxic disorders, such as lead poisoning, or any other disease of recognized etiology[vdh.virginia.gov]
  • […] life-threatening illness that results in hypotension and multiorgan failure Epidemiology incidence staphylococcal toxic shock syndrome is more common in women due to tampon use typically occurs within 5 days of onset of menses in women using tampons Etiology[medbullets.com]
  • Pending culture results, clindamycin or linezolid (to suppress toxin production) plus vancomycin, daptomycin, linezolid, or ceftaroline—empiric choices that cover the most likely etiologic organisms—should be used.[merckmanuals.com]

Epidemiology

  • This study aims to describe the epidemiology of streptococcal TSS in children and to determine whether adjunctive therapy with IVIG is associated with improved outcomes.[ncbi.nlm.nih.gov]
  • In this case report, we review the presentation and epidemiology of STSS and compare it to the more common staphylococcal toxic shock syndrome.[ncbi.nlm.nih.gov]
  • Global molecular epidemiology analysis has suggested that the frequency of emm3 GAS has been recently increasing.[ncbi.nlm.nih.gov]
  • Epidemiologic investigations of these cases, which were noted within 48 hours of each other, showed that the same surgeon performed the vaccination on patient 2 after assisting a colleague during the hernia repair procedure on patient 1.[ncbi.nlm.nih.gov]
  • More investigations are needed to improve the epidemiology and the pathogenesis of S. suis in human infection.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The presentation, pathophysiology, and management of invasive group A streptococcus and streptococcal toxic shock syndrome are reviewed.[ncbi.nlm.nih.gov]
  • Since then, although the pathophysiology of the syndrome has been clarified, mortality can be as high as 80%. A middle-aged female developed STSS associated with a group A streptococcal pneumonia.[ncbi.nlm.nih.gov]
  • This paper discusses the similarities and differences between the two toxic states, reviews the pathophysiology, and presents a case report of near-fatal streptococcal toxic shock-like syndrome secondary to a puncture wound of the foot.[ncbi.nlm.nih.gov]
  • Streptococcal Toxic Shock Syndrome (TSS) most frequently occurs in the setting infection due to group A Streptococcus (GAS; Streptococcus pyogene) Pathophysiology: Superantigens ![ucsfmed.wordpress.com]
  • Epidemiology incidence staphylococcal toxic shock syndrome is more common in women due to tampon use typically occurs within 5 days of onset of menses in women using tampons Etiology Staphylococcus aureus group A Streptococcus ( Streptococcus pyogenes ) Pathophysiology[medbullets.com]

Prevention

  • Aggressive and timely treatment are essential to preventing death.[ncbi.nlm.nih.gov]
  • We also review the potential preventive measures and treatment modalities for this syndrome. A 29-year-old primigravid presented at 36 weeks' gestation with diarrhea, abdominal pain, fever, and fetal bradycardia.[ncbi.nlm.nih.gov]
  • Her clinical presentation and laboratory findings meet the Centers for Disease Control and Prevention diagnostic criteria for streptococcal toxic shock syndrome. Her diagnosis was confirmed by autopsy.[ncbi.nlm.nih.gov]
  • The Working Group on Prevention of Invasive Group A Streptococcal Infections: Prevention of invasive group A streptococcal disease among household contacts of case-patients. Is prophylaxis warranted ? JAMA 1998, 279 ( 15 ):1206–1210.[link.springer.com]
  • JAMA. 1993 Jan 20;269(3):390-1. [2] Centers for Disease Control and Prevention.[bestpractice.bmj.com]

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