1/51. Infectious disease emergencies in primary care.Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.- - - - - - - - - - ranking = 1keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
2/51. Intravenous immunoglobulin as adjunctive treatment for streptococcal toxic shock syndrome associated with necrotizing fasciitis: case report and review.Streptococcal toxic shock syndrome (STSS) is caused by infection with a toxicogenic strain of streptococcus pyogenes. Clinical manifestations may be those of a mild illness, characterized by malaise, fever, and muscle pain, to severe sepsis and multisystem organ failure. The syndrome may be associated with several invasive infections including necrotizing fasciitis. Treatment is primarily surgical debridement of infected tissue with supportive care, antibiotics, and hemodynamic monitoring. Intravenous immunoglobulin (IVIG) is reported to have beneficial effects in the management of STSS associated with necrotizing fasciitis. The agent was successful in conjunction with surgical excision and antibiotics in a patient with necrotizing fasciitis, toxic shock, and multisystem organ failure. On the basis of this experience and a thorough literature review, we concur that IVIG may be a useful adjunct in the treatment of STSS associated with necrotizing fasciitis.- - - - - - - - - - ranking = 2.0170956748799keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
3/51. Necrotizing fasciitis caused by serratia marcescens in two patients receiving corticosteroid therapy.Necrotizing fasciitis (NF), a devastating soft tissue infection, is rarely attributed to serratia marcescens. We here report two patients with S. marcescens NF, both of whom had underlying renal disease and had been receiving corticosteroid therapy. The first patient, a 40-year-old man with systemic lupus erythematosus and uremia on prednisolone therapy, developed fulminant cellulitis and septic shock 1 month after a skin biopsy for cutaneous vasculitis of the left foot. The cellulitis evolved to NF, and blood and necrotic tissue cultures both grew S. marcescens. The patient completely recovered after debridement and ceftazidime therapy. The second patient, a 73-year-old man receiving prednisolone therapy for nephrotic syndrome, developed right leg cellulitis that evolved to NF. blood and necrotic tissue cultures both grew S. marcescens. After aggressive debridement and ciprofloaxcin therapy, the NF improved. However, the patient died of aspiration pneumonia and massive gastrointestinal bleeding 1 month later. These findings illustrate that S. marcescens should be considered as a potential pathogen causing NF in susceptible hosts.- - - - - - - - - - ranking = 0.047012398184916keywords = shock, septic shock (Clic here for more details about this article) |
4/51. Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient.Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.- - - - - - - - - - ranking = 1keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
5/51. Toxic shock syndrome after suction lipectomy.We present a case of toxic shock syndrome with necrotizing fasciitis after suction lipectomy. The patient underwent aesthetic suction lipectomy of the abdomen, buttocks, and thighs during an office procedure by a cosmetic surgeon. On postoperative day 2, the patient was referred to the emergency department of our hospital because of pain. On admission, the patient was in toxic shock. She required intensive medical treatment for about 1 month, along with psychiatric help to adapt after the illness. Although toxic shock syndrome is a rare postoperative complication, every plastic surgeon should be acquainted with it. A combination of early recognition, diagnosis, and aggressive supportive therapy is the only successful treatment.- - - - - - - - - - ranking = 3.2264953468563keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
6/51. culture independent and rapid identification of bacterial pathogens in necrotising fasciitis and streptococcal toxic shock syndrome by fluorescence in situ hybridisation.fluorescence in situ hybridisation (FISH) targeted to ribosomal rna is well established for studies in environmental microbiology. Initial applications of this technique in the field of medical microbiology showed that FISH is also a suitable means for the rapid, reliable and cultivation-independent identification of bacterial pathogens. In particular, for infectious diseases that follow a fulminant live-threatening course, such as sepsis or necrotising fasciitis (NF), a fast and reliable detection technique is of great importance. This study describes the development of an rRNA-targeted oligonucleotide set covering more than 95% of the pathogens associated with NF. These probes were tested with a broad collection of target and non-target organisms and found to be highly specific. Subsequently, the FISH approach was applied for the direct detection of bacterial pathogens in clinical samples. Two cases of NF and one case of streptococcal toxic shock syndrome (STSS) were analysed. FISH correctly identified almost all pathogens present in the samples examined within 2-3 h. However, proteus mirabilis, which was identified in one sample by conventional methods was detected as a rod-shaped bacteria but could not be identified by FISH, since no specific probe was available for this particular organism. In contrast, identification of pathogens in these samples by conventional laboratory methods took 48-72 h. Furthermore, in one patient with pre-sampling antimicrobial therapy bacteria could not be grown from any of the samples. FISH unequivocally revealed the presence of streptococcus pyogenes in affected tissue samples from this patient. In an experimental setting we demonstrated that FISH readily identifies S. pyogenes cells rendered non-cultivable by antibiotic treatment.- - - - - - - - - - ranking = 5keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
7/51. Necrotizing fasciitis secondary to group A streptococcus. morbidity and mortality still high.OBJECTIVE: To update physicians on Group A streptococcal necrotizing fasciitis, including current methods of diagnosis and treatment. QUALITY OF EVIDENCE: Current literature (1990-1998) was searched via medline using the MeSH headings necrotizing fasciitis, toxic shock syndrome, and Streptococcus. Articles were selected based on clinical relevance and design. Most were case reports, case series, or population-based surveys. There were no randomized controlled trials. MAIN MESSAGE: The hallmark of clinical diagnosis of necrotizing fasciitis is pain out of proportion to physical findings. Suspicion of underlying soft tissue infection should prompt urgent surgical examination. Therapy consists of definitive excisional surgical debridement in conjunction with high-dose intravenous penicillin g and clindamicin. risk factors for mortality include advanced age, underlying illness, hypotension, and bacteremia. CONCLUSION: Necrotizing soft tissue infections due to Group A streptococcus might be increasing in frequency and aggression. overall mortality remains high (20% to 34% in larger series). Clinical diagnosis requires a high level of suspicion and should prompt urgent surgical referral.- - - - - - - - - - ranking = 1keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
8/51. Necrotizing fasciitis.A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.- - - - - - - - - - ranking = 0.027188358537565keywords = shock (Clic here for more details about this article) |
9/51. Report of 2 fatal cases of adult necrotizing fasciitis and toxic shock syndrome caused by streptococcus agalactiae.We describe 2 cases of fatal necrotizing fasciitis and toxic shock syndrome caused by streptococcus agalactiae-a rare entity that has been reported in only 9 patients-in 2 nonpregnant adults.- - - - - - - - - - ranking = 5keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
10/51. Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus.A recent increase in reports of necrotizing fasciitis resulting from group B streptococcus has alerted physicians to a possible concomitant increase of toxic shock-like syndrome. We report the second case of group B streptococcus causing necrotizing fasciitis and toxic shock-like syndrome. A black woman, aged 52 years, with newly diagnosed diabetes mellitus had necrotizing fasciitis type II of the left groin. hypotension, elevated bilirubin and liver enzymes, and adult respiratory distress syndrome rapidly developed. Because group B streptococcus was isolated from a normally sterile site, the patient's condition met the criteria for toxic shock-like syndrome. Extensive surgical debridement, hyperbaric oxygen therapy, and intravenous antibiotic therapy (including clindamycin) were required for complete recovery. The antitoxin effects of hyperbaric oxygen therapy and clindamycin should be further investigated for the treatment of such patients.- - - - - - - - - - ranking = 1.2477031683935keywords = toxic shock, shock (Clic here for more details about this article) |
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