01:06,17,Aug,2006 | (515/0/0) | Original

toxic shock syndrome in dogs

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toxic shock syndrome in dogs

Introduction of a staphylococcal exotoxin caused by the syndrome, characterized by high fever, vomiting, diarrhea, confusion, and rash, can quickly progress to severe and refractory shock. Occurred mainly in the application of vaginal tampons in passing women. The main symptoms is due to the toxins produced by Staphylococcus aureus caused. Overview of toxic shock syndrome disease occurs mainly in the application of vaginal tampons in passing women. Because of the vaginal plug and the role of the diaphragm and some widely publicized
Tampon toxic shock withdrawal in the market, women in the sharp decline in the incidence of the disease. Lack some of the symptoms of less serious cases are quite common, small series of studies estimate the incidence of women walking about 3 / 100000, those who do not have vaginal plugs after surgery and postpartum women and women are still case report. Approximately 15% of the cases occurred in mothers or as a postoperative wound infections Staphylococcus aureus, often without obvious clinical manifestations. And influenza, cases of osteomyelitis, and cellulitis have been reported related. Disease causes the main symptoms of toxic shock syndrome due to Staphylococcus aureus caused by toxins produced. Bacteria often cause burns and from the weak after the operation
In patients with skin infections, toxic shock. In fact, the bacteria is not uncommon, is usually normal, harmless bacteria present in the vagina. How or why of Staphylococcus aureus causing toxic shock syndrome is not fully understood. But there are two conditions may be necessary: first, the bacteria need a rapid growth and the release of toxins in the envi
ronment; second, the toxin must enter the bloodstream, and in this cause serious fatal symptoms. One theory is that a tampon soaked in blood as a medium for the rapid growth of bacteria. Most of the tampon made of polyester foam, cotton and man-made fibers of its more than a bacterial culture medium. Menstrual sponge in the application, the vaginal diaphragm and cervical cap process, these materials are either placed in the vagina for a long time - more than 30 hours, or sponge cushion of sponge fragments remain in the vagina. For the two cases may provide a good environment for bacterial growth. Way to bacterial toxins enter the bloodstream may be related to the vaginal tampon application. The researchers found that vaginal tampon slip into the vaginal wall caused by micro-tearing, puncture the vessel wall. Especially the application of high performance tampon absorption, when the place too long or when there are fewer applications in the menstrual flow, can make the vagina too dry, easy to tear vaginal wall. Researchers have ruled out other causes toxic shock. Women and bath application of deodorant spray, underwear and other clothes do not work. In addition patients menstrual history, the application of drugs and alcohol, smoking, swimming, or bathing or sexual intercourse with toxic shock syndrome are not related. Sudden onset of disease symptoms, with persistent high fever, headache, sore throat, non-purulent conjunctivitis, deep lethargy, intermittent blurred consciousness without focal neurological signs, vomiting, profuse watery diarrhea and diffuse red sun-like disease. The syndrome can progress within 48 hours to orthostatic hypotension, syncope, Hugh
Toxic Hugh Keke and death. 3 days after the onset and 7, between the skin can occur and result in skin stripping off the debris and found especially in the skin of the palms and soles. Often involved in other organs, can cause mild non-hemolytic anemia, mainly by immature myeloid white blood cells increased in moderate and early thrombocytopenia and subsequent thrombocytosis. Although clinically significant bleeding rarely occurs, but the prothrombin time and partial thromboplastin time, there are extended orientation. Week 1 of the disease, laboratory tests often can be found in liver dysfunction (hepatitis) and rhabdomyolysis. Cardiopulmonary involvement may also occur, manifested as peripheral edema and pulmonary edema (central venous pressure is abnormally low, suggesting that adult respiratory distress syndrome), especially severe hypotension can occur in children and physically inadequate blood perfusion, and renal dysfunction is almost always It is characterized by reduced urine excretion and blood urea nitrogen and creatinine increase. Similar to toxic shock syndrome, Kawasaki syndrome (mucocutaneous lymph node syndrome), but can be identified based on clinical manifestations. Kawasaki syndrome generally occurs in children under 5 years old, does not cause shock, azotemia or thrombocytopenia, rash as the rash. There should also consider the identification of other scarlet fever, Reye syndrome, staphylococcal scalded skin syndrome, meningitis, bacteremia, Rocky Mountain spotted fever, leptospirosis and viral rash illness. These diseases can be based on specific clinical performance, culture and serological tests to be eliminated. Prevalent in the past body of clinical and health, menstrual day 1 to 6 young women, in particular, Tampons are menstrual applications, but can also occur in postmenopausal women, men
Toxic shock and children. Small number of patients before onset of general malaise, fever, myalgia, or vomiting prodrome. Rapid onset, more than a sudden high fever, body temperature can be higher than 38.9, often accompanied by chills. Hypotension usually occur within 72 hours in the heat, adult systolic blood pressure less than 90mmHg, with orthostatic syncope, or shock. Rash may occur on the first day, the most common manifestation of a wide range of erythema subsided within 3 days. Scarlet fever-like rash can also occur, and colliculus impetigo, hand, foot and was swelling. Can have a wide range of mucosal erythema, conjunctival hemorrhage, mouth, esophagus, vagina and bladder ulcer. Many accompanied by itching. Blisters and bullae may occur sometimes, rash, purpura. Scaling is highly characteristic, occurs in 10 to 21 days after onset, may be limited to the tip of finger or involving the palmoplantar skin or generalized. Reversible patchy hair loss or telogen hair loss, part of a transverse ridge and a late dropout is non-specific performance. Multiple organ system damage occur more frequently. Damage to the gastrointestinal system, vomiting, diarrhea; muscular system damage are muscle pain, elevated creatine phosphokinase; kidney system damage with renal failure, urinary creatinine increase, elevated blood urea nitrogen; liver damage with bilirubin, ALT , AST increased; blood system damage with platelets less than 100,000 / ram. ; The central nervous system damage or consciousness with disorientation and changes. Check one experiment, blood leukocyte count increased in most patients associated with a left shift, thrombocytopenia or increased in some patients, are sometimes visible cells are pigment
Toxic shock anemia. 2, prothrombin time and coagulation as kaolin partial thromboplastin time prolonged. 3, liver function tests Bilirubin, bilirubin, aminotransferase, γ glutamyl transferase, lactate dehydrogenase Dengjun see increased alkaline phosphatase activity in normal, serum total protein and albumin decreased. 4, renal function tests positive for urinary protein, we can see a lot of pus, but negative for bacterial culture of urine; see other tangible components. Increased blood urea nitrogen, serum creatinine also increased. 5, bacterial culture of the sick period, from the vagina or cervix, etc., they can nurture Staphylococcus aureus: non-menstrual period the sick, such lesions can be cultured from the body of bacteria. Staphylococcus aureus blood culture positive rate of 8l%. To isolate are generated for each SPE C and enterotoxin F. Diagnostic criteria for a fever the body temperature ≥ 38.9 ℃. 2, skin rash or erythroderma were diffuse type of rash, one for 12 weeks after the onset of scaling occurs.
3, toxic shock, hypotension, systolic blood pressure ≤ 12 dry kPa (90 mmHg), orthostatic hypotension, orthostatic syncope, or orthostatic diastolic blood pressure from supine to reduce dry ≥ 2 kPa (15 mmHg). 4, multiple organ damage over three or more, such as: â‘  Gastrointestinal: vomiting or diarrhea at onset; â‘¡ muscle: severe myalgia or creatine kinase ≥ twice the upper limit of normal; â‘¢ mucosa: conjunctiva, oropharynx, vaginal congestion caused by photophobia, subconjunctival hemorrhage, red sore throat, red bayberry tongue, genital swelling, etc.; â‘£ Renal: Urine ≥ 5 WBC / high power field, red blood cell ≥ 1  , protein ≥ (), or less. 5, no other clinical or laboratory evidence of disease of blood, pharynx, urine, cerebrospinal fluid culture negative bacteria (Staphylococcus aureus exceptions), leptospirosis, rickettsial and other serological tests were negative. Differential diagnosis of a non-Staphylococcus aureus septic shock patients may have fever, shock and other clinical manifestations, and also may be associated with several organ damage, easily with the
Toxic Shock sign confusion; but the former is a non-blood cultures of Staphylococcus aureus, can be funded difference. 2, scarlet fever when patients develop fever, rash, red bayberry tongue, etc., are easily confused with the sign; but the disease is caused by beta-hemolytic streptococcal infection, throat culture may be positive results, funding difference. 3, abrupt onset of leptospirosis, the patient manifested as fever, general myalgia. Headache, vomiting, liver and kidney dysfunction, etc., should be differentiated from the levy. The main point is that the former identification with water and other relevant epidemiological history, the first 5 days after onset, can be isolated from the patient's blood pathogen (79.5% blood culture positive), serum complement fixation test and agglutination test since the disease first dissolved positive after the weekend, sensitized sensitized hemagglutination test and test dissolution of red blood cells and urine of Nowicki's dissolution of the pilot, 3 days in patients positive rate of 80%, early diagnosis. 4, mucocutaneous lymph node syndrome or Kawasaki's disease, which is very similar with the TSS, both of fever, conjunctival hyperemia, rash, peeling recovery, toxicity symptoms, suggesting that a common pathogen. Todd and other reported 1 case. Shands et al (1980) that the adult Kawasaki's disease is probably TSS. 5, hemolytic uremic syndrome may have fever, vomiting, diarrhea, convulsions or coma, renal dysfunction, and TSS are similar; but the symptoms are severe and more microangiopathic hemolytic anemia (microngiopa-thichemolyticanemia ) (appears shaped red blood cells, such as stinging cells, triangle, crescent or red blood cell fragments, etc.) and the clotting mechanism, etc., it can be distinguished. Treatment of disease should be given appropriate systemic antibiotic treatment and systemic support therapy. Preferred β-lactamase-resistant antibiotics such as oxacillin (oxacillin), 6
Toxic shock ~ 8g / d; nafcillin (ethoxy naphthalene penicillin) 12 ~ 20g / d, intravenous infusion or intramuscular injection graded. Can also choose cefazolin, erythromycin, fluoroquinolones, cephalosporins, gentamicin. These antibiotics have good antimicrobial activity, should be combination therapy. Application of disease prevention than conventional vaginal tampon with a high water absorption of only the risk of thrombosis caused by much lower. Therefore, preventive measures are the most conservative use sanitary napkins. The following measures can also be used as little as possible to reduce the incidence of tampon, sanitary napkin can be used instead.
Less toxic shock absorbent tampon, because the amount of reduction of menstrual; every 8 hours for a tampon, when the period is over, make sure to remove the last tampon. If the application menstrual sponge, diaphragm or cervical cap, when not required, remember to remove it, in any case should not allow these items more than 24 hours in the vagina. After each application, the diaphragm with warm soapy water or cervical cap. Suspected as the toxic shock syndrome should be immediately hospitalized patients and enhance treatment. Immediate removal of the vaginal plug, diaphragm or other foreign matter. Must be fluid and electrolytes to prevent and treat hypovolemia, hypotension, or shock. Since the loss of fluid can be widely within the organization to the body, shock may be a deep and stubborn, so sometimes require a lot of fluid and electrolytes. From mucosal surfaces and blood specimens were taken for Gram stain and culture. After drawn by β-lactamase-resistant penicillin or cephalosporin therapy. Emergency response to toxic shock syndrome in the emergency room immediately hospitalized. If you suspect this disease should be treated as soon as possible. If you can not find a doctor, call the emergency phone
Toxic shock or immediate contact with the hospital emergency room. As a result of shivering in patients unable to drive yourself soon, so someone escort. The treatment of life-threatening illness should be quickly and efficiently. Doctors will use antibiotics for the staph infection, since the release of bactericidal effect and inhibition of its toxin. Other emergency measures, including blood transfusion, intravenous fluids and electrolytes to stabilize blood pressure, which control the body's reaction to the toxin, supporting the body vital functions is necessary. Some patients required ventilator-assisted breathing temporarily. In the acute stage, patients should be continued as the major life care. Clinical cases were hospitalized patients, diagnosis of infusion reactions and toxic shock syndrome diagnostic criteria. Section 3 cases transferred by the liver, and 1 by the tumor
Hugh Keke turn toxic. 3 males and 1 female, aged 55 to 65 years, mean 61.6 years old. Underlying disease: one case of chronic active hepatitis B, hepatitis B cirrhosis in 1 case, one case of alcoholic liver disease, lung cancer later in 1 case. Time of infusion reactions occurred in 5 to 30 days after admission. Infusion reaction occurs, enter the branch chain amino acid plus aspartic acid, potassium and magnesium in 3 cases, enter the compound of amino acids in 1. The main clinical features of all the patients had chills, fever, hypotension, nausea, vomiting, and varying degrees of hypoxemia, thrombocytopenia, and other multi-system dysfunction. Abdominal pain, diarrhea in 1 case, 2 cases of scarlet fever rash. The maximum temperature at 39.5 to 42 degrees of fever less than 1 day. Hypotension occurred in the heat before the pressure minimum in the 40 ~ 50/20 ~ 30mmHg, for 4 to 10 days. 2 patients with severe muscle pain, recovery perioral herpes simplex and oral ulcers. Laboratory examination of peripheral blood WBC,, 2 patients with liver diseases after transfusion reaction was a transient decrease, the next day were significantly increased in 4 cases, for 3 to 5 days, 94% neutrophils 97%. 4 cases of thrombocytopenia were significantly reduced. Urinary protein 4 () ~ (), 2 microscope see red, white and granular casts. Toxic shock syndrome Staphylococcus aureus bacteria mainly, the main toxin is toxic shock toxin. Gram-negative bacteria autolysis or decomposition, releasing heat of endotoxin, enter the patient's body heat and lead to endogenous cytokines induced, inflammatory response starts to enlarge, causing a series of pathophysiological changes, leading to toxic shock consolidated sign. This group of patients in the transfusion during or shortly after infusion chills, high fever, scarlet fever-like rash (2 cases because of early failure with severe hypotension observed in scarlet fever-like rash), multi-system damage, orthostatic hypotension (or shock) . And had severe underlying diseases, low immunity, increased susceptibility to the body. Blood and fluid cultures were negative in all over, fever and elevated blood independent of time, short duration, and soon returned to normal, and further suggest the occurrence of toxic shock syndrome toxins rather than bacteremia or sepsis. The liquid may be lost in the production process is not strict disinfection, leading to unspoiled toxins into the body, the cell composition of LPS on NO synthesis enzyme activation, resulting in a large number of NO generation, NO causes peripheral vasodilatation caused serious hypotension, and vasoactive substances in response to the reduced, which caused the low organ and tissue perfusion is the major cause of organ failure. The past, some doctors reluctant to NE, the main concern of the internal organs which may adversely affect blood flow, in particular, may adversely affect the kidneys. Recent studies have found that NE treatment of endotoxic shock moderate with good hemodynamic function, its therapeutic effect was better than DA and other positive inotropic drugs. NE also found in the clinical treatment of septic shock, not only did not reduce visceral blood flow, but instead enhance the internal organs of the oxygen supply, even the urine of patients with DA still no increase in urine output. Xin-Min Wu and other tests had confirmed that endotoxin shock dogs, NE combined than alone NE, DA better for improving cardiac function force shock dogs. Li Maoqin other confirmed NE dobutamine combined treatment of septic shock is the ideal combination. Combination of NE, DA, dobutamine for treatment of toxic shock syndrome, not only can reduce the dose of each drug, thereby reducing the incidence of arrhythmia and other adverse reactions, but also NE, DA elevated blood pressure in the joint still can patients, results were satisfactory. It should be noted, NE is a strong vasoconstrictor drugs, we applied 10 consecutive days, the puncture site localized vascular thrombosis, and the use of excessive NE, puncture injuries, hypotension, prolonged bed rest on. Therefore a large number of applications NE, recommended deep venous administration, to observe the blood vessels with or without tenderness at the line, time is too long or have high blood coagulation tendency of the best replacement. Amino acids as nutritional medicine is very easily contaminated and whether the application should be carefully observed before crystallization, and pay attention to patient response. Because few cases, joint NE, DA, dobutamine treatment 8FF boost efficacy remains to be further observation.
Toxic shock syndrome caused by what?
(A) etiology
Toxi
c shock syndrome the exact cause is unknown, but almost all cases were associated with phage group 1 of Staphylococcus aureus strains producing exotoxins related to the bacteria can produce toxic shock syndrome toxin -1 or related toxin, have been in the mucosal (nasopharyngeal, vaginal, tracheal), or necrosis separate parts (empyema, abscess), and passing through the discovery of such bacteria in the vagina of women, which speculated that the colony already exists in the vagina and the use of vaginal plugs the most dangerous women by the toxic shock syndrome, and vaginal plugs are likely related to mechanical or chemical factors have led to increased production of bacterial exotoxins, inside out toxins through the damaged mucosa or the uterus into the bloodstream.
Pathogenic toxins are Staphylococcus aureus (phage group I) produced by toxic shock syndrome toxin I (TSST-I), previously considered to be within the toxin Staphylococcus pyogenes exotoxin F or C caused occasional group A
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