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Case (65)

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Dr.Habiib:
A   young   menstruating   female   experienced   sudden    onset   of   fever,  diarrhea, vomiting  and red rash, plus  hypotension with cardiac and  renal   failure. Onset of disease was 5 days  from   onset      of menses. She was using   vaginal   tampons that were left in place for an extended period.

1. W hat is the most probable diagnosis?
2. What is the organism causing this condition?
3. What is pathogenesis of this   disease?
4. Describe the laboratory diagnosis of this disease.
5. Can this syndrome occurs  in man and non-menstruating female?

Muraad:
toxic shock syndrome
staph aureus and a more serious form is associated with strep pyogens.
a preformed exotoxin (TSST-1); TSST-1 is a superantigen that bnds to MHC II and T-cell receptor, whic resutlts in polycolonal T-cell activation.
If suspect TSS do labs for CBC, electrolytes, LFT, and renal function test. Abnormal renal functon test is consistent with TSS. IF woman do Pelvc exam and discard if there is a tampon. Lung X-ray helps to check if there is fluid accumulation, ECG.
In fact, one third of toxic shock syndrome occurs in men. Non-menstruating woman could be affected by TSS.

Dr.Habiib:


Thank you muraad your answer is correct 100%




ANSWERS:
1. Toxic shock syndrome (TSS).

2. The causative organism is  staphylococcus  aureus.

3. Pathogenesis of this condition (Toxic shock syndrome):
 It is result   superantigen action of   Toxic   Shock Syndrome Toxin-1 (TSST-1)  leads to over production of high level of cytokines that produce dramatic symptoms include cardiac and renal failure.
Mortality rate is   10-15%.

4. The laboratory   diagnosis:
Diagnosis usually depends on clinical findings but it can be made by examining vaginal swabs or tampons by and/ or ELISA   that detect   TSST-1.

5. The syndrome can also occurs in men and nonmenstuating females suffering staphylococcus aureus infection any where of body.

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