A 28-year-old menstruating woman appeared in the emergency room with the following signs and symptoms: fever, 104degF (40degC); WBC, 16,000/ uL; blood pressure, 90/65 mmHg; a scarlatiniform rash on her trunk, palms, and soles; extreme fatigue; vomiting; and diarrhea.The patient described in the case above most likely has
Correct Answer: Toxic shock syndrome
Description: Toxic shock syndrome (TSS) is a febrile illness seen predominantly, but not exclusively, in menstruating women. Clinical criteria for TSS include fever greater than 102degF (38.9degC), rash, hypotension, and abnormalities of the mucous membranes and the gastrointestinal, hepatic, muscular, cardiovascular, or central nervous system. Usually three or more systems are involved. Treatment is suppoive, including the aggressive use of antistaphylococcal antibiotics. Ceain types of tampons may play a role in TSS by trapping O2 and depleting magnesium. Most people have protective antibodies to the toxic shock syndrome toxin (TSST-1). Toxic shock syndrome (TSS) is caused by a toxin-producing strain of Staphylococcus aureus (TSST-1). While there have been repos that S. epidermidis produces TSS, they have largely been discounted. Vaginal colonization with S. aureus is a necessary adjunct to the disease. S. aureus is isolated from the vaginal secretions, conjunctiva, nose, throat, cervix, and feces in 45 to 98% of cases. The organism has infrequently been isolated from the blood Epidemiologic investigations suggest strongly that toxic shock syndrome is related to use of tampons, in paicular, use of the highly absorbent ones that can be left in for extended periods of time. An increased growth of intravaginal S. aureus and enhanced production of TSST-1 have been associated with the prolonged intravaginal use of these hyperabsorbent tampons and with the capacity of the materials used in them to bind magnesium. The most severe cases of TSS have been seen in association with Gram-negative infection. TSST-1 may enhance endotoxin activity. Recently, group A streptococci have been repoed to cause TSS. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
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Microbiology
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