Intensivmedizinische Besonderheiten beim toxischen Schocksyndrom ("toxic-shock-syndrome", TSS)

Abstract

Toxic-shock-syndrome (TSS) is an acute febrile, exanthematous illness caused by toxins such as toxic-shock-syndrome-toxine-1 (TSST-1) and other endotoxines from staphylococcus aureus with an incidence of 0,5 per 100.000 inhabitants. Patients with menstrual toxic-shock-syndrome (menstrual-TSS) usually have TSS associated with menstruation and use of a vaginal device such as tampons. Other patients with non-menstrual toxic-shock-syndrome (non-menstrual-TSS) have a focus of staphylococcal infection such as a surgical wound infection or soft tissue abscess. TSS usually presents with fever, pharyngitis, diarrhoea, vomiting, myalgia and may progress rapidly (within hours) to signs of hypovolaemic hypotension and shock. In some cases TSS is associated with multisystem failure including shock, renal failure, myocardial failure and adult respiratory distress syndrome. In its acute phase the diagnosis of TSS is often uncertain because of its initial symptoms are non-specific and numerous conditions need to be considered in the differential diagnosis. But obviously less incidence, the signs and symptoms of toxic-shock-syndrome should be recognised early to permit successful therapy. The site of infection should be adequately drained and treated with antimicrobial therapy. Possible complications including ARDS and myocardial failure require a thorough understanding of its underlying pathophysiology to ensure appropriate intensive-care treatment. Only if appropriate therapy is instituted as early as possible, most of patients will be able to survive their toxic-shock-syndrome. In other cases TSS can be a rapidly progressive and perhaps lethal ending disease because of possible multiple organe failure such as ARDS.

Use of Cannabinoids to Treat Acute Respiratory Distress Syndrome and Cytokine Storm Associated with Coronavirus Disease-2019

“…The copathogens include, Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, and the like (Lai et al, 2020). Some of these bacteria produce toxins such as Staphylococcus enterotoxin B (SEB) which can activate a large proportion of T cells, thereby causing cytokine storm, ARDS, and multiorgan failure (Lang et al, 2003). Also, as the coronavirus virus spreads, it is likely that the infection and the inflammation that ensues disrupt the normal microbiota found in the lungs, which leads to dysbiosis and emergence of pathogenic organisms, causing pneumonia and sepsis.…”

Toxisches Schocksyndrom durch Staphylococcus aureus im Kleinkindalter, eine (klinische oder laborchemische) Blickdiagnose?

“…Verschiedene Studien haben gezeigt, dass ein großer Anteil der erwachsenen Bevölkerung protektive Antikörper gegenüber TSST-1 im Blut aufweist [15]. An TSS erkrankte Patienten verfügen allerdings in über 90 % der Fälle nicht über einen protektiven antikörperassoziierten Immunschutz [8], wie dies auch bei unserer Patientin der Fall war. Bis zum Erwachsenenalter bilden die meisten Patienten Antikörper gegen TSST-1 [7,22], bei Kindern zwischen 7 Monaten und 2 Jahren finden sich in 30 % der Fälle AK [14,16].…”