Toxic Shock Syndrome due to Streptococcus Pyogenes: Case Report

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-05-01 DOI:10.1016/j.jemermed.2024.11.009

A. Ganss , S. Venturini , I. Reffo , M. Avolio , M. Domini , D. Rufolo , L. Corich , G. Del Fabro , A. Callegari , M. Crapis , G. Basaglia , G. Nadalin

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引用次数: 0

Abstract

Background

Toxic shock syndrome (TSS) is one of the most devastating clinical manifestations of Streptococcus pyogenes (also known as Group A Streptococci or GAS), characterized by an overwhelming production of toxins. The incidence of TSS is increasing worldwide, and the mortality rate remains unacceptably high. Due to the rapid progression of infection, rapid diagnosis is crucial, as early initiation of aggressive supportive measures, along with antibiotics, source control, immunoglobulin, and steroids, can improve patient outcomes. IgM- and IgA-enriched immunoglobulins represents a new therapeutic option, as highlighted in the case reported here.

Case report

A 66-year-old man was admitted for cellulitis of the right arm with shock, disseminated intravascular coagulation (DIC), renal and hepatic compromise, suggestive of toxic shock syndrome (TSS). Blood cultures revealed S. pyogenes, confirming the diagnosis. The patient was treated with combination antibiotic therapy (clindamycin, piperacillin/tazobactam), steroids and enriched immunoglobulins in addition to vasopressor and high flow oxygen. He was discharged home with complete recovery after 1 month.

Why Should an Emergency Physician Be Aware of This?

In the emergency department, the primary goals of management of TSS include aggressive resuscitation, prompt administration of appropriate antibiotics, source control if feasible, and early intensive care unit admission.

查看原文本刊更多论文

化脓性链球菌所致中毒性休克综合征1例报告。

背景：中毒性休克综合征（TSS）是化脓性链球菌（也称为A群链球菌或GAS）最具破坏性的临床表现之一，其特征是大量产生毒素。TSS的发病率在世界范围内不断增加，死亡率仍然高得令人无法接受。由于感染进展迅速，快速诊断至关重要，因为早期采取积极的支持措施，以及抗生素、源头控制、免疫球蛋白和类固醇，可以改善患者的预后。富含IgM和iga的免疫球蛋白代表了一种新的治疗选择，正如本文报道的病例所强调的那样。病例报告：一名66岁男性因右臂蜂窝织炎合并休克，弥散性血管内凝血（DIC），肾和肝损害，提示中毒性休克综合征（TSS）而入院。血液培养显示化脓性链球菌，证实了诊断。患者接受联合抗生素治疗（克林霉素、哌拉西林/他唑巴坦）、类固醇和强化免疫球蛋白、血管加压剂和高流量氧。1个月后完全康复出院。急诊医生为什么要意识到这一点？在急诊科，TSS管理的主要目标包括积极复苏，及时给予适当的抗生素，如果可行，源头控制，早期入住重症监护病房。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

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