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Transcript
Staphylococcal Toxic Shock Syndrome 1/9/10 PY Mindmaps A-Z Yung, A. et al (2004) “Infectious Disease: A Clinical Approach” Second Edition, IP Communications Ltd - staphylococcal toxin producing infection -> intoxication of exotoxins (TSS-1, 2 or 3 enterotoxin)-> toxic shock syndrome - TSST acts as a superantigen activating T-cells directly and causing massive cytokine release HISTORY - rapid onset - entry port for staphylococcus (tampon, swab, infected skin lesion, respiratory tract, post partum, osteomyelitis) - systemic symptoms (fever, chills, rigors) - myalgias - GI upset – vomiting and diarrhoea - headache - sore throat - shock with multi-organ failure EXAMINATION - fever tachycardia hypotension confusion generalised macular erythematous of skin with desquamation over time non-purulent conjunctivitis infected entry port INVESTIGATIONS - blood cultures (are usually negative) - routine bloods MANAGEMENT - early recognition - early and adequate antibiotic therapy - source control Resuscitation A – may be obtunded and require airway protection B – ventilation to relieve work of breathing, may develop ALI/ARDS Jeremy Fernando (2011) C – large bore IV access, aggressive fluid resuscitation – often require alot, inotropic and vasopressor support as tolerated, invasive monitoring Specific Therapy - remove source – remove tampon, debridement - antibiotics - flucloxacillin 50mg/kg Q 6hrly or cephazolin 50mg/kg Q8 hrly - clindamycin 25-40mg/kg/day in divided doses - controversial but believed to attenuate the toxin production - immunoglobulin IV 2g/kg LD -> 0.4g/kg for 5 days – mechanism uncertain ?binding of toxin - hyperbaric oxygen – controversial and not always readily available - low dose steroids – in refractory shock General Therapy Elevated creatinine and urea – fluid resuscitation Hypoglycaemia - replacement Low protein and albumin – supportive care Elevated bilirubin and transaminases – supportive care Metabolic acidosis – resuscitation Nutrition Thromboprophylaxis Jeremy Fernando (2011)
