1/17. Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/17. Severe invasive group A beta-hemolytic streptococcus infection complicating pharyngitis: a case report and discussion.Group A beta-hemolytic streptococcus (GABHS) has long been recognized as a deadly pathogen with manifestations ranging from impetigo to necrotizing fasciitis. bacteremia from streptococcal pharyngitis is a rare complication. We report a patient presenting with septic shock and diabetic ketoacidosis from streptococcal pharyngitis. The pathophysiology, classification, and treatment of invasive group A streptococcal infection is discussed.- - - - - - - - - - ranking = 1.2064009749297keywords = shock, septic shock (Clic here for more details about this article) |
3/17. Toxic shock-like syndrome with flu-like prodrome: a possible role of 'enhancing tissue focus' for streptococcal toxic shock.We describe three patients with invasive group A streptococcal infection, admitted during the 3 months between November 1996 and February 1997. All patients were previously healthy Japanese women who developed a profound shock, with a rapidly fatal outcome, after experiencing flu-like symptoms. All cases conformed to the case definition of toxic shock-like syndrome (TSLS).Currently, the pathogenic mechanism of TSLS remains unclear. Known microbial virulence factors can not sufficiently explain the occurrence of TSLS, and it has been generally considered that host factors may be contributory. On pathological examination, each patient had one organ or tissue that was most severely involved: Case 1 a non-penetrating trauma; Case 2 a pregnant uterus; and Case 3 a pulmonary lesion reminiscent of lymphocytic interstitial pneumonia. On the basis of clinicopathological features of these cases, we propose that the coexistence of 'enhancing tissue focus' may be one of host factors for the progression of TSLS in patients infected with non-invasive GAS.- - - - - - - - - - ranking = 61.372168901323keywords = toxic shock, shock (Clic here for more details about this article) |
4/17. Emergence of invasive group A streptococcal disease among young children.Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.- - - - - - - - - - ranking = 13.274433780265keywords = toxic shock, shock (Clic here for more details about this article) |
5/17. Streptococcal toxic shock syndrome due to noninvasive pharyngitis.Serious infections due to group A beta-hemolytic streptococcus (GABHS) have been reported with increasing frequency in recent years. We report a case of toxic shock syndrome (TSS) due to GABHS pharyngitis in an otherwise healthy 14-year-old boy. The organism was found to produce toxin A. To our knowledge, this is the second reported case of streptococcal TSS associated with the production of toxin A that is not associated with an invasive disease and the first case associated with a documented rise in the level of antibody to the streptococcal toxin itself. Clinicians must be especially vigilant for this entity in patients who have streptococcal pharyngitis because early recognition and institution of aggressive supportive therapy can be lifesaving.- - - - - - - - - - ranking = 305.71570051722keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
6/17. Lemierre's syndrome and genetic polymorphisms: a case report.BACKGROUND: Lemierre's syndrome presents a classic clinical picture, the pathophysiology of which remains obscure. Attempts have been made to trace genetic predispositions that modify the host detection of pathogen or the resultant systemic reaction. CASE PRESENTATION: A 17-year old female, with no previous medical history, was admitted to the intensive care unit for septic shock, acute respiratory distress syndrome and Lemierre's syndrome. Her dna was assayed for single nucleotide polymorphisms previously incriminated in the detection of the pathogen, the inflammatory response and the coagulation cascade. We observed functional variations in her Toll like 5 receptor (TLR 5) gene and two coagulation variations (Tissue Factor (TF) 603 and plasminogen-Activator-Inhibitor-1 (PAI-1) 4G-4G homozygosity) associated with thrombotic events. CONCLUSION: The innate immune response and the prothrombogenic mutations could explain, at least in part, the symptoms of Lemierre's syndrome. Genomic study of several patients with Lemierre's syndrome may reveal its pathophysiology.- - - - - - - - - - ranking = 1.2064009749297keywords = shock, septic shock (Clic here for more details about this article) |
7/17. Apparent increase in the incidence of invasive group A beta-hemolytic streptococcal disease in children.Recently, among adults, an increase in the incidence of invasive disease caused by group A beta-hemolytic streptococci (GABS) has been noted, as has the appearance of a severe illness called "toxic shock-like syndrome," also caused by GABS. We now report an apparent increase beginning in 1987 in the incidence of invasive disease caused by GABS in children. Among these patients the manifestations were varied. One child had signs and symptoms compatible with the streptococcal toxic shock-like syndrome. Among the GABS isolates from our patients, 8 (80%) of 10 evaluated for M-protein antigens were nontypeable. Further studies will be necessary to determine the relationship between serotypes and virulence of GABS. physicians should be aware of the possibility of an increasing incidence of invasive GABS disease in children, as well as its manifestations, which may include toxic shock-like syndrome.- - - - - - - - - - ranking = 33.823301340794keywords = toxic shock, shock (Clic here for more details about this article) |
8/17. arcanobacterium hemolyticum infection: confused with scarlet fever and diphtheria.arcanobacterium hemolyticum infections are a common cause of pharyngitis and rash in the 10- to 30-year-old age group. Despite its prevalence, many emergency and primary care physicians may not be aware of the pathogenic potential of this organism. We present a case that illustrates the distinctive clinical spectrum of A. hemolyticum infections that may be confused with drug allergy, group A streptococcal scarlet fever, diphtheria, and even toxic shock syndrome. Recognition of this syndrome will reduce misdiagnoses and facilitate appropriate treatment.- - - - - - - - - - ranking = 61.143140103444keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
9/17. Toxic shock syndrome associated with pharyngitis and submandibular space abscess.Toxic shock syndrome continues to be encountered more frequently with the head and neck areas as sources of the toxin. In head and neck surgery practice it is most commonly noted following nasal packing. An unusual case associated with staphylococcal pharyngitis and spontaneous submandibular space abscess is reported and the literature concerning the subject is reviewed. Treatment is eradication of the infective focus, aggressive support of vital functions, and parenteral antistaphylococcal antibiotics.- - - - - - - - - - ranking = 76.549598372697keywords = shock syndrome, shock (Clic here for more details about this article) |
10/17. Toxic streptococcal syndrome.The streptococcal toxic shocklike syndrome is a recently recognized, multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome, but is caused by toxins elaborated by group A beta-hemolytic streptococcus. We describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome (fever, hypotension, multisystem dysfunction, and diffuse macular erythroderma followed by desquamation) and who demonstrated serologic evidence suggesting streptococcal infection. In patients presenting with clinical findings consistent with a toxic shocklike syndrome, the emergency physician should consider streptococcal infection as a potential etiology.- - - - - - - - - - ranking = 144.83514776742keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
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