Micro Winter 13 Toxic Syndromes

Front 1

ET-A and ET-B are associated with what

Back 1

Staph scalded skin syndrome, these are super AG, epiderolytic toxin (ET), serine protease

A- chromosomal
B- plasmid

**intraepidermal splitting of tissues and necrosis, cleaves desmoglein

Front 2

What does s aureus need to have to cause sss

Back 2

2 Super AG 1. ETA- chromosomal 2. ETB- plasmid (ET- epidermoltic toxin- both are serine proteases)

Front 3

What is Ritter disease

Back 3

sss of infants

Front 4

What is staph scalded skin styndrome

Back 4

toxin mediated dermatitis, superficial blistering and exfoliation, follows a red rash

Front 5

What causes SSS

Back 5

staph aureus (toxin mediated, superficial blister then peel)

Front 6

the Epidermolytic toxin seen in SSS is the same as what? what is teh difference

Back 6

same as bullous impetigo

SSS- systemic toxin
Bullous impetigo- toxin is LOCAL

Front 7

who gets SSS

Back 7

neonates, <5 yo. ET+ strains of staph aureus is rare

*common in kids bc they dont have specific immunity and they have immature renal clearance

**introduced by an adult carrier who is asxmatoic

Front 8

why do kids get SSS more than adults

Back 8

immature immune system, immature renal clearance (this is how ET toxin is excreted)

*intorduced by asymptomatic adult carrier

Front 9

what adults get SSS

Back 9

RARE, but especially rare in adults

immunicimprimised or renal failure adults get it (same as kids- immature immune system, renal immaturity)

Front 10

what does SSS look like in an infant

Back 10

nose, throat, umbilicus, eyes

fever, orange/red, maculara tender blanching rash--> fast progression of rash into scarlitiniform (blistering eruptions)

Front 11

what is scarlatiniform

Back 11

blistering eruptions rash, seen as the rash progresses in SSS (24-28 hrs, acute)

Front 12

as the rash in SSS progresses we get blistering eruptions called what? what other things are common

Back 12

scarlatiniform

also get red mucous membranes, conjunctivitis
bullea
tissue paper like wrinkling of the epidermis
Nikolskys sign- pressure applied to skin seperates it from upper epidermis

*desquamation

Front 13

what is Nikolsky's sign

Back 13

seen in SSS, pressure allpied to skin will cause it to seperate from upper epidermis

Front 14

does the skin desquamate in SSS
can you culture S aureus from leision

Back 14

yep

nope, its a systemic toxin that causes disease (ET-A/B)

Front 15

after the blistering, bullea, and desquamtion in sss will the lesions scar

Back 15

nope

**decline 5-7 days after disease start

Front 16

what is the decline stage in adults like for SSS

Back 16

get bacteremia and pneumonia, no scarring of leisions

Front 17

what is the tx for SSS

Back 17

IV-AB: penicillinase resistant antistaphylococcal AB: nafcillin or oxacillin

recall its caused by S aureus ET toxin

**skin ointment
**maintain fluids/electrolyte

Front 18

how can you prevent the SSS in the neunatal unit

Back 18

wash hands- chlorhexidine
barrier nursing protocol
*mupirocin in carriers


**recall often babes get it from asymptomatic adult carriers. babes are immature immune/renal

Front 19

whats TSS
whats STSS

Back 19

TSS- staphy toxic shock syndrome
STSS- strep toxic shock syndrome

**both are acute febrile illnesses with red eruptions, systemic involvement

Front 20

are the toxins with TSS super AG

Back 20

oh ya!

activate 20% of t cells, secrete IL1 nad TNF

T cell mitogens- division and cytokine secretion

**cause MUCH of the pathology

Front 21

how do super AG ework?

Back 21

not specific stim of T cells

bind to MHC II directly and activates 1/5 T cells (20%)
release TONS of cytokines (IL1, TNF)

Front 22

what causes TSS

Back 22

staphy toxic shock, staph aureus

MRSA, MSSA. also causes SSS with it has ET

Front 23

is TSS common? is it deadle

Back 23

2-5% mortality

15-45 a year

s aureus is found in nose, armpit, vagina, rectum

Front 24

what are hyperabsorbant tampons associated with

Back 24

TSS- staph aureus

((TSST-1)
increases PO2 of vagina, supply surfactant, binds Mg

the vagina is colonized and makes toxin during menses, then there is toxin absorption

Front 25

is TSS only associated with tampons and menstruation

Back 25

nope!

postpartum, surgical, ainusitis, etc

kids can have cutaneous and non surgical lesions

Front 26

whats TSST1

Back 26

toxic shock syndrome toxin 1
most of the menstural and half of non menstrual cases

Front 27

other than TSST1 what toxins are associated with staph TSS

Back 27

SEB- implicated in TSST1 mutant strains

SEA- cofactor with TSST1

Front 28

what does the immune system have to do with TSS

Back 28

most ppl have AB resistance

**pts with TSS wont have AB to it

Front 29

what can you tell me about AB production in pts with TSS

Back 29

lack AB to TSST1, cant make AB
INFg inhibits polyclonal Ig production to TSST`

Front 30

what is the pathogen in STSS

Back 30

strep! strep pyogenes, GAS

SPEA: primary, strep pyogenes exotoxin
SPEB, SPEC: massive cytokine release

Front 31

what are some of the toxins associated with STREP TSS

Back 31

Streptolysin O- synergist with SPEA from staph TSS

M protein (recall M1/3 with necrotizing fasciatis)

Front 32

what does a strep pyogenes GAS colony look like

Back 32

mucoid with hyaluronic capsule

Front 33

does strep TSS have AB

Back 33

no! no protective immunity as was seen in TSS

Front 34

what is the pathogenesis of STSS

Back 34

strep- cause invasive disease: necrotizing fasciatis, cellulitis, myositis

Front 35

who gets TSS STSS

Back 35

young adults (contrast to SSS which was infants)

TSS- 15-35
STSS- 20-50

**young nad old untreated will likely die due to infecion

Front 36

what predisposes ppl to staph TSS

Back 36

s aureus cellulitis
influenza
sinisutis
tracheitis
IV drug use
HIV
post op
gynecological infection

Front 37

what predisposes to strep TSS

Back 37

type II necrotizing fascitis

strep myositis

Front 38

how can you dx TSS caused by staph aures

Back 38

fever, rash, shock/hypotension,

**desquamation of palms/soles 1-2 weeks later

Front 39

which disease has desquamation of palms and soles

Back 39

TSS cause by staph aureus

Front 40

do pts with TSS get HTN or hypotension

Back 40

hypotension! also orthostatic syncope

Front 41

what does it mean that there is multi system involvement with TSS infection

Back 41

3 or more are involvef

GI- NV diarrhea
Muscular- myalgia
Mucous Membrane Hyperemia: vagina, oral, conjunctival
Renal: Increased BUN, createnine, pyuria
Liver: total biliruben increases
PLatelets: decrease
CNS: confusion

Front 42

what does the lab workup for TSS look like

Back 42

negative!

**can have S aureus in blood
**serology for RMSF, leptospirosis, measles

Front 43

what is the criteria for probable and confirmed cases of TSS

Back 43

Probable: meets lab and 4/5 clinical manifestations

Confirmed: meets lab criteria. 5/5 criteria. AND desquamation (palms/soles)

Front 44

in STSS do you have HTN or hypotension, waht about multisystem involvement

Back 44

HTN- like TSS

also multisystem involvement but 2 or more (TSS was 3 or more)

Front 45

what are the systems involved with strep STSS

Back 45

remember its TWO or more, not 3 or more as was seen in TSS

1. Renal
2. Coagulopathy: platelets, DIC
3. Hematic: tss
4. ARDS:
5. Rash
6. Soft Tissue Necrosis: fascitis, myositis, gangrene, increased creatine kinase

Front 46

what are the labs associated with STSS

Back 46

isolation of group A streptococcus

Front 47

what does the dx of probable and confirmed cases of STSS

Back 47

Probable: meets clinical of 2 or more systemic, no other cause, isolation of GAS from non sterile sites

Confirmed: meets clinical, isolation of GAS from STERILE sites

Front 48

whats the tx for TSS/STSS

Back 48

O2
IV fluids
IVIG- neutralize TSS toxin
AB- TSS: staph aureus- clindamcin, vancomycin
STSS- strep pyogenes: clindamycin