Toxic shock syndrome - what is it and who is at risk? Toxic shock syndrome: causes and signs of the condition. Why is it dangerous? Staphylococcal shock

What is Toxic Shock Syndrome?

Toxic shock syndrome is rare and often a life-threatening illness that develops suddenly after infection and can immediately affect multiple organ systems, including the lungs, kidneys, and liver.

Because toxic shock syndrome progresses rapidly, immediate medical treatment is necessary.

What Causes Toxic Shock Syndrome?

Toxic shock syndrome is rarely the result of bacterial infection Streptococcus pyogenes(group A streptococcus) or Staphylococcus aureus(staphylococcus). These bacteria produce toxins that cause toxic shock syndrome. These bacteria are common but usually do not cause problems. They can cause easily treatable throat or skin infections, such as a sore throat or impetigo. In rare cases, toxins enter the bloodstream and cause a strong immune response in people whose bodies do not fight the toxins. The body's response causes symptoms associated with toxic shock syndrome.

Often appears after childbirth, flu, chicken pox, surgery, small cuts to the skin, wounds or bruises that cause bruising but do not break the integrity of the skin.

Often appears after prolonged use of tampons (menstrual toxic shock syndrome) or after a surgical procedure such as nasal surgery using a dressing (nonmenstrual toxic shock syndrome).

Pathogenesis (what happens?) during Toxic Shock Syndrome

The immune reaction leading to toxic shock syndrome is usually due to a lack of specific antibodies against streptococcal or staphylococcal toxins. Young people may not have such antibodies.

Outbreaks of toxic shock syndrome disease can occur in hospitals and long-term care facilities where people live in close proximity to each other.

Symptoms of Toxic Shock Syndrome

Rapid development of symptoms is one of the most important symptoms that may require immediate treatment for toxic shock syndrome.

Symptoms of toxic shock vary in severity depending on the type of streptococcal or staphylococcal bacteria.

Symptoms of toxic shock syndrome develop quickly and can cause death within 2 days.

The first signs of toxic shock syndrome usually include:
- Severe flu-like symptoms such as muscle aches and pain, stomach cramps, headache or sore throat.
- Sudden rise in temperature above 38.9 C.
- Vomiting and diarrhea.
- Signs of shock, including low blood pressure and rapid heart rate, often with dizziness, loss of consciousness, nausea, vomiting, or dysphoria and confusion.
- Redness similar to sunburn. Redness may appear in several parts of the body or in specific areas, such as the armpits or groin.
- Severe pain at the site of infection (if there is a wound or damage to the skin).
- Redness of the nasal passages and mouth.

Other symptoms of toxic shock syndrome may include:
- Conjunctivitis (redness).
- Involvement of more than one organ system, usually the lungs or kidneys.
- Blood poisoning (sepsis), which affects the entire body.
- Death of skin tissue (necrosis), which appears at the beginning of the syndrome.
- Peeling of skin tissue that appears during recovery.

Streptococcal nonmenstrual toxic shock syndrome.
Symptoms usually develop:
- In women who have recently given birth, 2-3 days or several weeks after birth.
- In people with infected surgical wounds, 2 days to 1 week after surgery.
- In people with respiratory diseases, 2-6 weeks after the onset of respiratory symptoms.

Staphylococcal menstrual toxic shock syndrome. Symptoms usually develop 3-5 days after the start of menstruation when a woman uses tampons.

Staphylococcal nonmenstrual toxic shock syndrome. Symptoms usually develop within 12 hours of surgery that uses surgical dressings, such as rhinoplasty.

Symptoms of toxic shock syndrome can suddenly affect several different organ systems, including the lungs, kidneys, and liver.

Redness similar to a sunburn may also appear early in the disease. Redness usually appears after 7-14 days on the palms of the hands and soles of the feet.

Toxic shock syndrome occurs less frequently in children compared to adults.

Dangerous complications of toxic shock syndrome include:
- Shock, causing a reduction in blood circulation and oxygen in vital organs.
- Acute respiratory failure syndrome. Lung function decreases, it becomes difficult to breathe, and oxygen levels in the blood drop.
- Disseminated intravascular coagulation syndrome. This disease is caused by a blood clotting factor. Many blood clots can form throughout the body. This may cause excessive bleeding.
- Kidney failure, also called end-stage renal disease. - Kidney failure occurs when kidney damage is so severe that treatment with dialysis or a kidney transplant is necessary to prevent death.

Talk to your doctor about possible complications if you have had multiple menstrual toxic shock syndromes.

Diagnosis of Toxic Shock Syndrome

Because toxic shock syndrome progresses rapidly, it is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory test results. Additional blood and tissue testing can help determine the type of bacteria causing the infection.

Typically, by the time a person with toxic shock syndrome sees a doctor, the disease progresses rapidly and the person feels very unwell. Shock usually needs to be treated before any test results are available.

If your healthcare provider suspects you have toxic shock syndrome, you will undergo several types of tests, including:
- Complete clinical blood test- counting red and white blood cells, platelets and other basic indicators of your blood.
- Cultures of blood and other fluids and tissues body for signs of streptococcal or staphylococcal bacteria. For menstrual toxic shock syndrome, a sample of vaginal fluid is tested. For nonmenstrual toxic shock syndrome, a swab or tissue sample is taken from a suspected lesion or other injured area of ​​the body. Blood culture usually does not detect staphylococcal toxic shock syndrome when it is present, but streptococcus can be detected in a blood or cerebrospinal fluid sample or by tissue biopsy. Cultures from the throat, vagina, or saliva may also reveal bacteria.
- Fluorography to look for signs of lung damage (respiratory distress syndrome).
- Tests to detect other infections which can cause symptoms similar to those of toxic shock syndrome, such as blood poisoning (sepsis), a tick-borne bacterial infection (American tick-borne rickettsiosis), a bacterial infection caused by contact with the urine of an infected animal (leptospirosis), or typhoid fever.

Sometimes other tests are needed, depending on how the disease has progressed and what problems it has caused.

Treatment of Toxic Shock Syndrome

Emergency treatment often requires intravenous plasma volume resuscitation and intensive care in the hospital, especially when the body is in shock. Further treatment includes antibiotics to kill the bacteria, removal of any source of infection, and treatment of any complications. Unless there are other complications, most people recover within 2 weeks when treated with antibiotics.

If you think you have toxic shock syndrome, call your doctor right away. If you have symptoms of shock such as severe weakness, dizziness or loss of consciousness, call an ambulance immediately. Because toxic shock syndrome can cause life-threatening complications, you may need to be treated in a hospital where your condition can be closely monitored.

By the time a person with toxic shock syndrome sees a doctor, emergency treatment is usually required. Because toxic shock syndrome can progress very quickly and be life-threatening, treatment is almost always done in a hospital where the patient is closely monitored. Treatment for shock or organ failure is usually necessary before the results of any tests are known. Admission to intensive care is usually necessary when a patient shows signs of shock or trouble breathing (respiratory failure).

Treatment for streptococcal or staphylococcal toxic shock syndrome includes:
- Removing the source of infection. If a woman uses tampons, a diaphragm or a contraceptive sponge, they should be removed immediately. Infected wounds are usually cleared of bacteria. Your doctor may give you an injection to numb the area so that you can use a scalpel or scissors to remove dead or severely infected tissue. This is called debridement. Once the source of infection is removed, the patient's condition often improves quickly.
- Treatment of complications of the disease, including low blood pressure, shock and organ failure. The specifics of treatment depend on what problem arose. The administration of large amounts of intravenous fluid is usually used to replace fluid losses from vomiting, diarrhea and fever in order to avoid complications such as low blood pressure and shock.
- Antibiotics to kill bacteria that produce toxins that cause toxic shock syndrome. Clindamycin stops the production of toxins and immediately treats symptoms. Other medications, such as cloxacillin or cefazolin, may be added when laboratory tests have detected specific streptococcal or staphylococcal bacteria. Staphylococcus aureus strains may be resistant to drugs such as cloxacillin and cefazolin, which are widely used around the world. These staphylococcal strains are called methicillin-resistant Staphylococcus aureus (MRSA). Other antibiotics may be needed to kill these bacteria. These antibiotics include vancomycin, daptomycin, linezolid, or tigecycline.

With timely treatment and the absence of serious complications, most patients recover within 1-2 weeks.

Streptococcal toxic shock syndrome has a mortality rate of about 50%. This may be because streptococcal toxic shock syndrome can be difficult to identify until serious complications such as blood poisoning (sepsis) or a rare bacterial infection that destroys the skin (necrotizing fasciitis) occur.

Staphylococcal toxic shock syndrome is serious, but leads to death in only 5% of people who are not diagnosed and treated correctly.

Toxic shock syndrome is a rapidly progressive, life-threatening illness that cannot be treated at home. If you think you may have toxic shock syndrome, seek medical help immediately.

Antibiotics are used to treat toxic shock syndrome. The sooner therapy begins, the fewer possible complications may occur. Antibiotics are used for as long as needed, depending on the streptococcal or staphylococcal bacteria and the severity of the symptoms.

Antibiotics may also help prevent recurrent episodes of toxic shock syndrome.

Intravenous immunoglobulin administration may be used when toxic shock syndrome is severe or the patient's condition does not improve after taking antibiotics. IV immune globulin works differently than antibiotics. It contains antibodies that can help the body remove specific toxins that cause toxic shock syndrome. But experts have not determined whether intravenous immunoglobulin is effective in treating toxic shock syndrome.

Your doctor can give you blood pressure medications to help your organs function better.

For toxic shock syndrome caused by staph bacteria, surgery is rarely required but is part of the necessary treatment. In some cases, surgical removal of infected tissue leads to significant improvement in the patient's condition. For example, surgery may be necessary when:
- Toxic shock syndrome has developed after surgery and the surgical suture must be drained and cleaned to remove the source of infection.
- Streprococcal bacteria cause necrotizing fasciitis, a bacterial infection that destroys the skin, and the dead tissue and toxins produced by the bacteria must be removed.

Streptococcal toxic shock syndrome with necrotizing fasciitis progresses rapidly and is life-threatening, requiring emergency surgery to remove the source of infection.

In the hospital, you may need intravenous fluids and simple protein to replace what your body has lost.

Prevention of Toxic Shock Syndrome

You can take the following steps to prevent toxic shock syndrome:
- Do not use tampons or barrier contraceptives during the first 12 weeks after birth, when the risk of developing toxic shock syndrome is high.
- Follow the instructions on the package when inserting tampons, diaphragms or contraceptive sponges. Change your tampons at least every 8 hours, or only use tampons a few hours a day. Do not leave the diaphragm or contraceptive sponge in for more than 12-18 hours.
- Keep all skin wounds clean to prevent infection and promote healing. This includes cuts, punctures, scrapes, burns, insect or animal bites, and surgical stitches.
- Do not allow children to scratch chickenpox sores.
- If you have already had menstrual toxic shock syndrome, do not use tampons, barrier contraceptives such as a diaphragm, cervical cap, sponge, or intrauterine device (IUD).

Careful use of tampons, diaphragm and contraceptive sponge
- Follow package directions when inserting tampons, diaphragms, and contraceptive sponges.
- Wash your hands with soap and water before inserting or removing tampons, diaphragms, or contraceptive sponges.
- Change tampons at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm and contraceptive sponge inside for more than 12-18 hours.
- As an alternative to tampons, use pads. For example, use pads at night and tampons during the day.
- Use tampons with a lower absorbency rate than you need. The risk of toxic shock syndrome is highest when using superabsorbent tampons.

Caring for skin wounds to prevent skin infections
- Keep all skin wounds clean to prevent infection and promote healing. Skin damage, including cuts, burns, bruises, insect and animal bites, chickenpox sores, and surgical stitches.
- Make sure children do not scratch chickenpox sores.

Preventing streptococcal infections during pregnancy or after childbirth

Women who are pregnant or have recently given birth have an increased risk of developing streptococcal toxic shock syndrome, especially if one of her children has strep throat. Any pregnant or postpartum woman with a baby who is showing signs of a sore throat should talk to her gynecologist or obstetrician.

Which doctors should you contact if you have Toxic Shock Syndrome?

Infectious disease specialist
Reanimatologist

The long weekend is coming, and many Russians will go on holiday outside the city. It's a good idea to know how to protect yourself from tick bites. The temperature regime in May contributes to the activation of dangerous insects...

05.04.2019

The incidence of whooping cough in the Russian Federation in 2018 (compared to 2017) increased almost 2 times 1, including in children under the age of 14 years. The total number of reported cases of whooping cough for January-December increased from 5,415 cases in 2017 to 10,421 cases for the same period in 2018. The incidence of whooping cough has been steadily increasing since 2008...

20.02.2019

Chief children's phthisiatricians visited school No. 72 in St. Petersburg to study the reasons why 11 schoolchildren felt weak and dizzy after they were tested for tuberculosis on Monday, February 18

18.02.2019

In Russia, over the past month there has been an outbreak of measles. There is a more than threefold increase compared to the period a year ago. Most recently, a Moscow hostel turned out to be a hotbed of infection...

Medical articles

Almost 5% of all malignant tumors are sarcomas. They are highly aggressive, rapidly spread hematogenously, and are prone to relapse after treatment. Some sarcomas develop for years without showing any signs...

Viruses not only float in the air, but can also land on handrails, seats and other surfaces, while remaining active. Therefore, when traveling or in public places, it is advisable not only to exclude communication with other people, but also to avoid...

Regaining good vision and saying goodbye to glasses and contact lenses forever is the dream of many people. Now it can be made a reality quickly and safely. The completely non-contact Femto-LASIK technique opens up new possibilities for laser vision correction.

Cosmetics designed to care for our skin and hair may actually not be as safe as we think

Tampons appeared in the distant 30s. Since that time, they have become a real lifesaver for girls. Thanks to these hygiene products, during your period you can wear tight clothes, play sports, dance, go to the pool and not feel any discomfort.

But many gynecologists are against tampons. Some health problems are associated with their use: thrush, inflammatory processes, dysbacteriosis. Tampon shock is the most dangerous disease. How to avoid unpleasant consequences from using these hygiene products, we will consider in the article.

Toxic shock syndrome

Toxic shock syndrome (TSS) is a manifestation of severe intoxication (poisoning) of the body with bacteria. The disease develops at lightning speed and always occurs in an acute form.

It is important! You will not be able to cope with toxic shock syndrome on your own. At the first symptoms of the disease, a woman must seek medical help. Otherwise, complications can spread to the kidneys and liver, up to complete failure of these organs.

Toxic shock syndrome is caused by a number of bacteria and microorganisms:

• streptococci;
• staphylococci;
• malarial plasmodium.

Bacteria “throw out” toxins into the blood, thereby poisoning the woman’s body. Through the plasma they reach the main vital organs (liver, kidneys, brain), and the patient experiences an acute pathological condition.

Why don't all women who use tampons during their periods suffer from TSS? The thing is that most adults have already encountered similar bacteria or microorganisms at least once in their lives and have developed antibodies to toxins.

That is why toxic shock syndrome in most cases is observed in adolescents and girls under 30 years of age.

The first signs of TSS resemble the common flu:

• increased body temperature (above 39 degrees);
• blood pressure surges;
• convulsions;
• dizziness and loss of consciousness;
• body aches.

Many patients think that they have caught a regular flu virus and begin active treatment for a cold, not realizing the seriousness of the situation. The insidiousness of toxic shock syndrome is that the disease develops rapidly. If you do not remove the tampon in time and do not seek medical help, you can experience complications, including death.

Read also 🗓 Full review of Ola gaskets

When using tampons, the causes of toxic shock syndrome may include:

1. Violation of vaginal microflora, inflammatory processes.
2. Constant use of tampons, without alternating with pads.
3. Wrong choice of hygiene product. For example, a tampon that is too large swells very quickly, increases in size and injures the walls and mucous membrane of the vagina.
4. Using tampons at night. Gynecologists prohibit doing this.
5. Insufficient hygiene.

The tricky thing about TSS is that it can start suddenly even after using tampons for a long time. Therefore, it is very important to visit a gynecologist at least once every six months so as not to miss this insidious disease.

First symptoms

TSS occurs very quickly during menstruation and is always acute. Without proper treatment, death can occur within 3–4 days.

That is why every girl who uses tampons should know the symptoms of toxic shock syndrome:

1. Low blood pressure. There is perspiration and pale skin on the patient's face. It gets to the point where the woman cannot remain in an upright position and loses consciousness.
2. Increased body temperature (39-40 degrees).
3. Nausea, vomiting, loose, foamy stools.
4. Muscle pain, cramps.
5. Redness of the throat mucosa.
6. The occurrence of conjunctivitis, souring of the eyes.
7. Small amount of urine.
8. Swelling of the genital organs.
9. Sharp pain in the lower abdomen and lumbar region.
10. Labored breathing.
11. On days 4-5, red spots may appear on the skin, which look more like burns.
12. On days 7-14, the skin on the palms and soles begins to peel and peel off.
13. Development of sepsis.
14. Damage to the liver, kidneys, central nervous system.

It is important! If, while using tampons, your stomach hurts severely, your temperature rises, or your blood pressure drops, seek medical help immediately. In 80% of cases, the doctor will diagnose TSS. You should not wait for accompanying symptoms and worsening of the condition. At the initial stage, toxic shock syndrome responds well to treatment, complications are extremely rare.

Specific treatment for toxic shock syndrome

It is worth remembering that TSS is an insidious disease that progresses very quickly. Therefore, his treatment will be long and painful.

First aid for a woman who detects symptoms of TSS should be as follows:

1. Removing the tampon.
2. Ventilate the room so that there is access to oxygen.
3. Relief from constricting, closed clothing.
4. Bed rest.
5. Warm heating pad for your feet.
6. Call an ambulance.

Read also How to make tampons with levomekol ointment in gynecology

This disease can only be treated in a hospital under the constant supervision of doctors. Treatment is as follows:

1. Antibiotic therapy. It is aimed at combating the causative agent of the disease. Drugs are prescribed individually after passing a series of tests. The course is at least 10 days.
2. Sanitation of a bacterial focus. After removing the tampon, the woman must be examined by a doctor in a gynecological chair. The vagina is washed with a special solution; if large wounds or tissue damage are found, they are excised.
3. Infusion therapy. It is aimed at restoring the desired blood composition, eliminating the patient’s state of shock, and normalizing the volume of fluid in the body. They use platelet mass, plasma injection, electrolytes, and often use blood transfusions.
4. Drugs that normalize blood pressure. As a rule, droppers are used to speed up the process.

If the patient has complications with the respiratory or cardiovascular system, additional treatment is necessary. Doctors often resort to artificial ventilation of the lungs and the administration of immunoglobulin.

Prevention of the syndrome

Is it really impossible to avoid TSS when using tampons? To prevent this disease, doctors advise adhering to the following rules:

1. The time of using tampons should not exceed 4 hours. In this case, the risks of developing pathogenic bacteria are minimized. In isolated cases, the time can be increased to 8 hours. After this, be sure to wash yourself with intimate hygiene gel to restore the vaginal microflora, and put on a pad.
2. Do not use tampons at night.
3. Choose the right size of hygiene product and its absorbency.
4. Alternate wearing tampons with pads.
5. Choose hygiene products of appropriate, proven quality. Make sure that the tampon does not contain genetically modified cotton, which is often used by manufacturers to reduce the cost of the product. If this component is present, the risk of developing staphylococcal toxins increases dramatically.
6. If after using a tampon there is itching, burning or redness in the vagina, it is better to avoid these hygiene products.

The life of a modern girl is designed in such a way that she always needs to be in shape, even during her period. Undoubtedly, tampons are simple and convenient to use, they are invisible under clothing and do not hinder movement. But, nevertheless, every girl, using these hygiene products, should know and use the rules that were described above. In this case, the risks of developing TSS are minimal.

ITS or infectious toxic shock is a sharp decrease in blood pressure due to a person being affected by infectious bacteria. Their toxic effects put the body into shock. The syndrome is caused by the action of endo- and exotoxins or viruses and disrupts the functioning of vital systems, primarily the cardiovascular, nervous and respiratory systems. This exacerbation requires immediate medical intervention, without which the risk of death increases.

Causes

• open wounds (burns);
• positive HIV status;
• development of infection on postoperative sutures (or introduced during surgery);
• sepsis (postpartum);
• typhoid fever and others;
• drug use (intravenous);
• use of tampons.

Today there is an opinion that non-steroidal anti-inflammatory drugs can cause infectious-toxic shock. But there is no 100% confirmed data.

Stages of infectious-toxic shock

After toxins enter the blood, infectious-toxic shock develops in three stages:

• The early stage is compensated shock.

  The patient is clearly conscious, but there is anxiety. The mucous membranes and tongue turn red (in some cases, the feet and palms), swelling of the face occurs, breathing is erratic, the pulse ranges from 110 to 120 beats/min, but may at times return to normal. Blood pressure rises, and difficulties arise with urination (urine output decreases). Diarrhea and pain in the upper abdomen are most often characteristic of children.

• The most pronounced stage is subcompensated shock.

  The patient is overcome by apathy, his actions and thought processes are difficult. The skin becomes cold, damp and pale. Nails and limbs turn blue, the temperature drops critically, shortness of breath appears, and the heart rhythm is disturbed, which can reach up to 160 beats/min. Blood pressure also drops to critical levels, urine output is difficult (most often absent in the second stage). Markings similar to bruises or a rash that resembles sunburn appear on the skin. The possibility of gastric bleeding cannot be ruled out.

• The last stage is decompensated shock.

  The patient's consciousness is confused, there is no reaction to the outside world, and constant fainting cannot be ruled out. The limbs turn blue, body temperature drops below normal levels, and blood pressure is sometimes not monitored. Urination is completely absent, shortness of breath increases. In some cases, the patient may fall into a coma.

Symptoms

• the occurrence of symptoms similar to those of the flu (sore throat, aches, discomfort in the stomach);
• a sharp rise in temperature to 39 degrees;
• consciousness becomes confused, vomiting, fainting, and causeless anxiety begin;
• A rash appears in the groin and armpits. Redness of the mucous membrane;
• pain in the area of ​​the infected wound.

• peeling of the skin on the extremities;
• blood poisoning;
• : blepharitis, etc.;
• skin neurosis.

Diagnosis

Due to the fact that infectious-toxic shock rapidly progresses, it is diagnosed only by the symptoms that appear. Treatment is prescribed before laboratory tests respond, since tests only establish the type of infectious agent. To do this, the following series of analyzes is required:

• chest x-ray;
• blood analysis;
• urine test (if the patient is in the first stage of ITS);
• smears of mucous membranes.

Treatment

• intravenous administration of drugs such as Dopamine and Dexamethasone;
• the use of antibiotics and antibacterial drugs (cephalosporins) is necessary;
• elimination of allergic reactions;
• elimination of oxygen starvation (if the condition worsens, connect to an artificial respiration apparatus);
• to eliminate intoxication, use the drug Enterosgel or its analogue, but at the same time protect the body from dehydration;
• blood purification with saline solution, administration of albumin or aminophylline to eliminate hemorheological disorders;
• therapy is prescribed aimed at restoring the immune system;
• in the first days, the patient is fed through a catheter to relieve the stomach and give it time to recover;
• if necessary, surgically remove the source of infection.

Emergency care for infectious-toxic shock

If the first symptoms go unnoticed, the skin becomes pale and cold, the skin on the extremities peels off, and the nails take on a blue tint and, when pressed, the white marks last for more than three seconds - this indicates a worsening of the situation and the onset of the second stage. Before the ambulance arrives, the patient must provide independent first aid:

• free from tight clothing;
• lay on your back with your head slightly raised;
• warm your feet;
• give the patient constant access to fresh air.

• increased oxygen flow (oxygen mask);
• installation of an intravenous catheter;
• administration of glucocorticoid (dexamethasone and prednisolone);
• urgent hospitalization of the patient in a hospital (in the last stages in intensive care).

Special cases

In children

The first symptom is high temperature, sometimes reaching critical limits of 41 degrees. The child's consciousness is confused, there is motor agitation, vomiting, and headache. Convulsions may occur. The mucous membranes and skin turn pale, severe chills occur, the pulse is weakly palpable, and the heart rate increases. Blood pressure drops, which can lead to acute renal failure.

In addition to diseases, infectious-toxic shock can be caused by scratching scratches, burns or abrasions. It is worth paying attention to all, even minor, injuries of the child, treating them in a timely manner and changing bandages. Infectious-toxic shock requires immediate hospitalization in the intensive care unit, since any delay can be fatal.

In obstetrics

• abortions during which an infection was introduced into the body;
• C-section;
• Chorioamnionitis.

Symptoms begin to appear within a few hours in the form of an increase in temperature to 39-40 degrees, rapid heartbeat and wheezing in the lungs. Pulmonary failure progresses, turning into pulmonary edema, the feeling of anxiety can sharply change to an apathetic state, the skin takes on a purple tint, and the lips and fingertips turn blue. After 12 hours, a hemorrhagic rash appears, and blood pressure decreases. As shock increases, partial or complete failure of some internal organs is observed, and acute renal failure develops.

Treatment should be prescribed without delay, because in such cases the probability of death reaches 60-70%. Antibacterial therapy is prescribed with removal of the purulent focus or drainage of the uterus.

For pneumonia

Among the initial symptoms, respiratory alkalosis, cerebral disorders expressed through apathy or anxiety, and hyperventilation may be observed. Often, these symptoms may not attract attention, which does not allow the disease to be detected in time, thereby worsening the prognosis for recovery. With the progression of toxic shock, shortness of breath increases, tachycardia and a tendency to hypertension appear. The skin becomes warm and dry.

Treatment is carried out with antibacterial therapy under constant monitoring and recording of all clinical data.

Consequences and prognosis

Possible complications:

• rhabdomyolysis;
• renal and liver failure;
• DIC syndrome;
• cerebral edema;
• encephalopathy.

Prevention

• quit bad habits that destroy the immune system;
• treat all possible diseases immediately and completely if possible;
• take vitamins and minerals that strengthen the immune system;
• treat all skin damage with an antiseptic, change bandages in a timely manner;
• do not allow children to scratch chickenpox wounds;
• do not self-medicate infectious diseases;

As a preventative measure, it is better for women after childbirth to refrain from using tampons.

Next article.

Symptoms include high fever, hypotension, a diffuse erythematous rash, and multiple organ failure that can rapidly progress from severe to intractable shock. Diagnosis is made clinically and by isolation of the microorganism. Treatment includes intensive therapy, administration of antibacterial drugs and immunoglobulin.

Toxic shock syndrome is caused by exotoxin-producing cocci. S. aureus phage group 1 strains transform toxic shock syndrome toxin 1 or related exotoxins; Certain strains of 5. pyogenes produce at least 2 exotoxins.

Toxic shock syndrome of staphylococcal etiology. Women with existing staphylococcal colonization of the vagina and who use tampons are at high risk. Mechanical or chemical factors associated with tampon use likely increase the production of exotoxins or facilitate their entry into the bloodstream through mucosal injury or through the uterus. Cases of toxic shock syndrome are recorded in women after undergoing operations and as a complication in the postpartum period. Approximately 15% of cases occur after childbirth or as a complication of postoperative staphylococcal wound infections, which often appear minor. Cases of the development of toxic shock syndrome have also been observed in patients suffering from influenza, osteomyelitis and cellulitis.

Mortality due to staphylococcal toxic shock syndrome< 3%. Рецидивы встречаются среди женщин, которые продолжают использовать тампоны во время первых 4 месяцев после перенесенной инфекции.

Toxic shock caused by streptococci. The syndrome is similar to that caused by S. aureus, but the mortality rate is higher (20-60%). In addition, approximately 50% of patients have S. pyogenes bacteremia and 50% have necrotizing fasciitis (neither of these conditions occurs in staphylococcal toxic shock). Patients are usually healthy children or adults. Primary infections of the skin and soft tissue are more common than in other sites.

Toxic shock syndrome due to S. pyogenes is diagnosed as any group A β-hemolytic streptococcal infection associated with organ failure and shock. Risk factors for developing this condition include minor trauma, surgery, viral infections (eg, chicken pox), and use of nonsteroidal anti-inflammatory drugs.

Symptoms and signs of toxic shock syndrome

The disease begins acutely with a rise in temperature, with fever (39°-40.5°C, temperature remains elevated), hypotension, diffuse macular erythroderma and damage to at least 2 other organ systems.

Toxic shock caused by staphylococci is likely to cause vomiting, diarrhea, myalgia, elevated creatinine kinase levels, mucosal inflammation, liver damage, thrombocytopenia, and confusion. The staph rash from toxic shock syndrome will most likely peel off, especially on the palms of the hands and soles of the feet, between days 3 and 7 after the onset of the disease.

Toxic shock caused by streptococci is usually manifested by respiratory distress syndrome, coagulopathy and liver damage and, most often, an increase in temperature to high numbers (39 °, 40 ° C), malaise and severe pain at the site of infection in the soft tissues.

Kidney failure is common and common in both conditions. The syndrome may progress over 48 hours to syncope, shock, and death. Less severe cases are quite common.

Diagnosis of toxic shock syndrome

• Typical clinical picture.
• Bacteriological inoculation on nutrient media.

The diagnosis is made clinically and by isolating the microorganism by blood culture (for Streptococcus) or by localization. Toxic shock syndrome resembles Kawasaki disease, but Kawasaki disease usually occurs in children younger than 5 years and does not cause shock, azotemia, or thrombocytopenia; maculopapular skin rash. Other disorders to consider are scarlet fever, Reye's syndrome, staphylococcal scalded skin syndrome, meningococcemia, Rocky Mountain spotted fever, leptospirosis, and viral exanthematous diseases. With the above diseases, differential diagnosis should be carried out, cultures of infectious material should be carried out, and serological tests should be performed.

Specimens for culture can be taken from any lesion, nasopharynx (for staphylococci), oropharynx (for streptococci), vagina (for both types of organisms), and blood samples. MRI or CT scan of soft tissues is indicated for focal infection. Constant monitoring of the function of the kidneys, liver, bone marrow and cardiopulmonary system is necessary.

Treatment of toxic shock syndrome

• Antibiotic therapy: use of β-lactams (eg, penicillin) and clindamycin.

Patients suspected of having toxic shock syndrome should be immediately admitted to the intensive care unit. The main suspicious locations of outbreaks should be carefully examined and treated. Treatment includes repeated examinations, reinspection and irrigation of postoperative wounds with antiseptics, even if they seem healthy; removal of necrotic (non-viable) tissues around postoperative wounds, sanitation of natural habitat areas of potentially dangerous microorganisms (sinuses, vagina). Replenishment of water and electrolyte balance is necessary to relieve hypovolemia, hypotension and shock. Because tissue fluid loss can be systemic (due to capillary effusion syndrome and hypoalbuminemia), shock becomes persistent and widespread. Active fluid restoration and circulatory support are sometimes required.

Such infections require intensive treatment. If S. pyogenes is isolated, give a β-lactam (eg, penicillin) plus clindamycin, continue treatment for 14 days, the most effective treatment is antibiotics. In recent years, community-acquired methicillin-resistant S. aureus has emerged in many geographic regions. Community-acquired methicillin-resistant S. aureus is often multiresistant compared with hospital-acquired methicillin-resistant S. aureus. Although these strains are resistant to most drugs, antibiotics are necessary; prescribed during the acute stage of the disease, they can sanitize pathogenic foci and prevent relapses. Passive immunization to toxic shock syndrome toxins by intravenous immunoglobulin (400 mg/kg) is indicated for severe cases of both types of toxic shock syndrome and lasts for several weeks, but the disease may not produce active immunity, so relapses are possible.

If serological testing for the presence of antibodies to toxic shock syndrome toxin-1 in paired sera (in the acute phase and in the convalescent phase) was negative in women with toxic shock syndrome due to staphylococci, should refrain from using tampons and cervical caps, blockers and aperture All women, regardless of toxic shock syndrome antibody status, should be advised to change tampons frequently or use absorbent pads, and to avoid highly absorbent tampons.