Treatment includes antibiotics, intensive ...

Toxic shock syndrome (TSS) is caused by staph or strep exotoxins. Symptoms include high fever, hypotension, diffuse erythematous rash and multiple organ failure, which can rapidly progress to severe and difficult to shock. Diagnosis is made clinically and by body fluids. Treatment includes antibiotics, active support, and immunoglobulin. TSS is caused by exotoxins producing coca. Strains of phage group 1

produce at least 2 exotoxins. Women who present staphylococcal colonization of the vagina and using tampons that are most at risk. Mechanical and chemical factors associated with tampon use likely to increase the production of exotoxins or facilitate its entry into the bloodstream through the mucous or break through the uterus. Estimates made from small series suggest about 3 cases per 100,000 menstruating women still take place and the cases are still observed in women not using tampons, women who underwent surgery, and in the postpartum period for women. About 15% of cases occur postpartum or as a complication of postoperative staphylococcal wound infections, which often seem insignificant. Cases have also been reported in patients with influenza, osteomyelitis, or cellulitis. 3%. Relapses are common among women who continue to use tampons for the first 4 months after the episode. Staphylococcus aureus, but higher mortality (20 to 60%). In addition, about 50% of patients have

S. pyogenes

bacteremia and 50% were necrotic fastsyyt (has to do with staphylococcal TSS). Patients are generally in healthy children and adults. Primary infection in the skin and soft tissue more frequently than elsewhere. Unlike staphylococcal TSS, streptococcal TSS, likely cause of acute respiratory distress syndrome (HRDS), and less common cause skin reactions. S. pyogenes

-hemolytic streptococcus (b-SJA) infections associated with shock and multiple organ failure. Risk factors for TSS buy strattera online b-SJA include minor trauma, surgery, viral infection (such as chicken pox), and use NPVS. Start a sudden, with high temperature (39

40. >> 5 << C, which remains high), hypotension, diffuse macular erythroderma, and participation at least two other systems. Staphylococcal STSH can cause vomiting, diarrhea, pain in muscles, increased CK, mucositis, liver damage, thrombocytopenia, and confusion. Staph rash TSS, likely to peel off, especially on the palms and soles, from 3 to 7 days after onset. Strep TSS usually causes respiratory distress syndrome, coagulopathy, and liver damage and is likely to cause fever, malaise, and pain at the site of soft tissue infections. Renal failure is a frequent and common to both. This syndrome may progress for 48 h to fainting, shock and death. Less severe cases of staph TSS occur frequently. ) Or from a local site. TSS resembles Kawasaki disease, Kawasaki disease but usually occurs in children

5 years old and does not cause shock, azotemia, or thrombocytopenia, skin rash papuleznaya. Other violations that would be considered scarlet fever, Reye's syndrome, staphylococcal scalded skin syndrome, meninhokokkemiya, spotted fever Rocky Mountains, leptospirosis, and viral diseases ekzantematoznyy. These disorders are excluded specific clinical differences between cultures and serologic tests. Specimens for culture should be obtained from any defeat, nose (for staphylococci), throat (for streptococci), vagina (for both), and blood. MRI or CT of the soft tissues may help in the localization of foci of infection. Continuous monitoring of kidney, liver, bone marrow and cardiopulmonary function is needed. Patients with suspected STS should be hospitalized immediately and treatment intensity. Tampons, diaphragms and other foreign objects must be removed immediately. Suspected major sites should be disinfected thoroughly. Decontamination includes re-inspection and irrigation of surgical wounds, even if they seem healthy, repeated surgical treatment of nonviable tissue and irrigation potential naturally colonized sites (sinuses, vagina). Fluid and electrolytes to replace for the prevention and treatment of hypovolemia, hypotension and shock. Loss of fluid in the tissues may occur in the body (through systemic capillary leak syndrome and hypoalbuminemia), the shock can be profound and persistent. Aggressive fluid therapy and circulatory support is sometimes required. Obvious Infection should be treated. If

S. pyogenes

isolated lactam

(eg, penicillin), and

-(900 mg intravenously 8 h d) lasts for 14 days is the most effective antibiotic treatment. If methicillin-resistant S.

Aureus (MRSA) is suspected or confirmed,,,, or Tigecycline shows (see

). Antibiotics given during the acute illness may eradicate foci of the pathogen and prevent recurrences. Passive immunization in TSS toxins with IV immunoglobulin (400 mg / kg) was useful in severe cases, both types of TSS and lasts for a week, but the disease can lead active immunity, so the possible recurrence. If the test for seroconversion in serum antibodies to TSST-1 in acute and recovery phase paired sera negative women who had a staph TSS, should probably refrain from using tampons and cervical caps, plugs, and diaphragm. Advising all women, regardless of TSST-1 antibody status, change tampons frequently or use instead of napkins and tampons avoid hyperabsorbent seems reasonable. Last full review / revision December 2009 Larry M. Bush, MD, Fred Chaparro-Rojas, MD; Maria T. Perez, MD