There is an increase in TNFα, and increase in IL-1 and IL-6 that result in systemic inflammatory response syndrome. In addition bradykinin results in vasodilation. The bacterium is the stationary part of the growth cycle and release of exotoxin is the major mediator in the pathogenesis of streptococcal TSS.
Question 4: What are the risk factors for the development of streptococcal TSS?
|Source control:||Surgical exploration and debridement|
|Fluid resuscitation:||Crystalloids may be infused to maintain blood pressure|
|Antibiotics:||Streptococcus pyogenes remains sensitive to penicillin however due to the toxin mediated pathogenesis of TSS an antibiotic that inhibits protein synthesis is often a better choice. Clindamycin has been shown to be more effective in the treatment of TSS. It is able to inhibit exotoxin and M protein synthesis. It also has a longer half-life than penicillin.|
|Supportive care:||Intensive care as well as offering ventilation, inotropic support and haemodialysis if necessary.|
|Immunoglobulin:||Intravenous immunoglobulin has been shown to reduce mortality by 40% in a single randomized controlled trial. Other trials have not shown such a dramatic improvement in mortality. The immunoglobulins have a neutralizing effect on the exotoxins. Currently the recommendation is that the immunoglobulin be given early and 2 doses may be more beneficial than a single dose.|
Complications of Group A Streptococcus infection?
CDC Streptococcal toxic-shock syndrome (STSS) (Streptococcus pyogenes) 2010 Case Definition
Gerald L Mandell. (2010). Principles and Practice of Infectious Diseases. Philadelphia: Churchhill Livingstone Elsevier.
Jessica Darenberg. (2003). Intravenous immunoglobulin G therapy in Streptococcal Toxic Shock Syndrome: A European randomized double-blind placebo-controlled trial. Clinical infectious diseases, 333-337.
Kaul, R. (1999). Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group. Clinical infectious diseases, 800-807.
Stevens, D. L. (1995). Streptococcal Toxic-Shock Syndrome: specturm of disease, pathogenesis and new concepts in treatment. Emerging infectious diseases, 69-78.
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