Toxic shock syndrome

Staphylococcus aureusand Streptococcus pyogenes(group A streptococci) are Gram-positive pathogens capable of producing a variety of bacterial exo-toxins known as superantigens. Superantigens interact with antigen-present-ing cells (APCs) and T cells to induce T cell proliferation and massive cytokine production, which leads to fever, rash, capillary leak and subse-quent hypotension, the major symptoms of toxic shock syndrome.

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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Toxic shock syndrome responsive to steroids...

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Streptococcal Toxic Shock Syndrome: Treatment In light of the possible role of pyrogenic exotoxins or other streptococcal toxins in streptococcal TSS, treatment with clindamycin has been advocated by some authorities (Table 130-3), who argue that, through its direct action on protein synthesis, clindamycin is more effective in rapidly terminating toxin production than penicillin—a cell-wall agent. Support for this view comes from studies of an experimental model of streptococcal myositis, in which mice given clindamycin had a higher rate of survival than those given penicillin.

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Confluent Desquamative Erythemas These eruptions consist of diffuse erythema frequently followed by desquamation. The eruptions caused by group A Streptococcus or Staphylococcus aureus are toxin mediated. Scarlet fever (Chap. 130) usually follows pharyngitis; patients have a facial flush, a "strawberry" tongue, and accentuated petechiae in body folds (Pastia's lines). Kawasaki disease (Chaps. 54 and 319) presents in the pediatric population as fissuring of the lips, a strawberry tongue, conjunctivitis, adenopathy, and sometimes cardiac abnormalities.

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Pathogenesis of Fever Pyrogens The term pyrogen is used to describe any substance that causes fever. Exogenous pyrogens are derived from outside the patient; most are microbial products, microbial toxins, or whole microorganisms. The classic example of an exogenous pyrogen is the lipopolysaccharide (endotoxin) produced by all gramnegative bacteria. Pyrogenic products of gram-positive organisms include the enterotoxins of Staphylococcus aureus and the group A and B streptococcal toxins, also called superantigens.

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