Streptococcal Toxic Shock Syndrome: A Case Series Emphasizing the Urgency of Recognition and Tailored Treatment

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Ehsan Yavari MD , Gaurav Puri MD
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引用次数: 0

Abstract

Background

Streptococcal toxic shock syndrome (TSS) is a rare but lethal condition associated with Streptococcus Pyogenes Group A (GAS). With rising incidence and high mortality, timely recognition and management are crucial. This case series presents two adult TSS cases caused by invasive GAS, highlighting the importance of early identification and multidisciplinary management.

Case Presentations

The first case involves a 42-year-old male who presented with fever, dizziness, and a tender, erythematous olecranon following an elbow laceration. Despite negative imaging for necrotizing fasciitis, a positive throat swab for GAS prompted immediate broad-spectrum antibiotics and aggressive resuscitation. Clindamycin and intravenous immunoglobulin were administered. The patient developed TSS and acute kidney injury, requiring intensive care and hemodialysis. The second case features a previously healthy 43-year-old female presenting with systemic symptoms and a rash, without trauma history. Positive GAS blood cultures confirmed TSS, leading to similar management and subsequent renal complications requiring hemodialysis.

Why Should an Emergency Physician Be Aware of This?

These cases highlight the evolving epidemiology of invasive GAS infections and the associated risk of TSS. Early identification and appropriate tailored treatment are essential to reduce morbidity and mortality, especially given the recent surge in invasive GAS. Clinical vigilance for skin changes and thorough laboratory investigations, including non-sterile site cultures, are critical. Early identification enables the use of adjunctive treatments like clindamycin and IVIG, and facilitates appropriate de-escalation of antibiotics. Prompt consultation with infectious disease, intensive care, and surgical teams is necessary to ensure optimal treatment.
链球菌中毒性休克综合征:一个强调认识和治疗紧迫性的病例系列。
背景:链球菌中毒性休克综合征(TSS)是一种与化脓性链球菌a群(GAS)相关的罕见但致命的疾病。随着发病率和死亡率的上升,及时识别和管理至关重要。本病例系列报告了两例由侵袭性气体引起的成人TSS病例,强调了早期识别和多学科治疗的重要性。病例表现:第一个病例涉及一名42岁男性,他在肘部撕裂伤后表现为发烧、头晕和鹰嘴发软、红斑。尽管坏死性筋膜炎影像呈阴性,但咽拭子gaas阳性提示立即使用广谱抗生素和积极复苏。给予克林霉素和静脉注射免疫球蛋白。患者出现TSS和急性肾损伤,需要重症监护和血液透析。第二例为既往健康的43岁女性,出现全身症状和皮疹,无创伤史。GAS阳性血培养证实TSS,导致类似的处理和随后需要血液透析的肾脏并发症。急诊医生为什么要意识到这一点?这些病例突出了侵袭性GAS感染的流行病学演变和TSS的相关风险。早期识别和适当的定制治疗对于降低发病率和死亡率至关重要,特别是考虑到最近侵入性气体的激增。临床警惕皮肤变化和彻底的实验室调查,包括非无菌部位培养,是至关重要的。早期发现有助于使用克林霉素和免疫球蛋白等辅助治疗,并有助于适当减少抗生素的用量。及时咨询传染病、重症监护和外科团队是确保最佳治疗的必要条件。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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