Micro Winter 13 Toxic Syndromes Flash Cards

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Title: Micro Winter 13 Toxic Syndromes
Description: micro
Number of Cards: 48
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Author: jessica.prentice7
Created: 2012-01-02
Tags: micro
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    • Question
    • Answer
    • Side 3
    • ET-A and ET-B are associated with what
    • 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
    • What does s aureus need to have to cause sss
    • 2 Super AG 1. ETA- chromosomal 2. ETB- plasmid (ET- epidermoltic toxin- both are serine proteases)
    • What is Ritter disease
    • sss of infants
    • What is staph scalded skin styndrome
    • toxin mediated dermatitis, superficial blistering and exfoliation, follows a red rash
    • What causes SSS
    • staph aureus (toxin mediated, superficial blister then peel)
    • the Epidermolytic toxin seen in SSS is the same as what? what is teh difference
    • same as bullous impetigo

      SSS- systemic toxin
      Bullous impetigo- toxin is LOCAL
    • who gets SSS
    • 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
    • why do kids get SSS more than adults
    • immature immune system, immature renal clearance (this is how ET toxin is excreted)

      *intorduced by asymptomatic adult carrier
    • what adults get SSS
    • RARE, but especially rare in adults

      immunicimprimised or renal failure adults get it (same as kids- immature immune system, renal immaturity)
    • what does SSS look like in an infant
    • nose, throat, umbilicus, eyes

      fever, orange/red, maculara tender blanching rash--> fast progression of rash into scarlitiniform (blistering eruptions)
    • what is scarlatiniform
    • blistering eruptions rash, seen as the rash progresses in SSS (24-28 hrs, acute)
    • as the rash in SSS progresses we get blistering eruptions called what? what other things are common
    • 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
    • what is Nikolsky's sign
    • seen in SSS, pressure allpied to skin will cause it to seperate from upper epidermis
    • does the skin desquamate in SSS
      can you culture S aureus from leision
    • yep

      nope, its a systemic toxin that causes disease (ET-A/B)
    • after the blistering, bullea, and desquamtion in sss will the lesions scar
    • nope

      **decline 5-7 days after disease start
    • what is the decline stage in adults like for SSS
    • get bacteremia and pneumonia, no scarring of leisions
    • what is the tx for SSS
    • IV-AB: penicillinase resistant antistaphylococcal AB: nafcillin or oxacillin

      recall its caused by S aureus ET toxin

      **skin ointment
      **maintain fluids/electrolyte
    • how can you prevent the SSS in the neunatal unit
    • wash hands- chlorhexidine
      barrier nursing protocol
      *mupirocin in carriers


      **recall often babes get it from asymptomatic adult carriers. babes are immature immune/renal
    • whats TSS
      whats STSS
    • TSS- staphy toxic shock syndrome
      STSS- strep toxic shock syndrome

      **both are acute febrile illnesses with red eruptions, systemic involvement
    • are the toxins with TSS super AG
    • oh ya!

      activate 20% of t cells, secrete IL1 nad TNF

      T cell mitogens- division and cytokine secretion

      **cause MUCH of the pathology
    • how do super AG ework?
    • not specific stim of T cells

      bind to MHC II directly and activates 1/5 T cells (20%)
      release TONS of cytokines (IL1, TNF)
    • what causes TSS
    • staphy toxic shock, staph aureus

      MRSA, MSSA. also causes SSS with it has ET
    • is TSS common? is it deadle
    • 2-5% mortality

      15-45 a year

      s aureus is found in nose, armpit, vagina, rectum
    • what are hyperabsorbant tampons associated with
    • 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
    • is TSS only associated with tampons and menstruation
    • nope!

      postpartum, surgical, ainusitis, etc

      kids can have cutaneous and non surgical lesions
    • whats TSST1
    • toxic shock syndrome toxin 1
      most of the menstural and half of non menstrual cases
    • other than TSST1 what toxins are associated with staph TSS
    • SEB- implicated in TSST1 mutant strains

      SEA- cofactor with TSST1
    • what does the immune system have to do with TSS
    • most ppl have AB resistance

      **pts with TSS wont have AB to it
    • what can you tell me about AB production in pts with TSS
    • lack AB to TSST1, cant make AB
      INFg inhibits polyclonal Ig production to TSST`
    • what is the pathogen in STSS
    • strep! strep pyogenes, GAS

      SPEA: primary, strep pyogenes exotoxin
      SPEB, SPEC: massive cytokine release
    • what are some of the toxins associated with STREP TSS
    • Streptolysin O- synergist with SPEA from staph TSS

      M protein (recall M1/3 with necrotizing fasciatis)
    • what does a strep pyogenes GAS colony look like
    • mucoid with hyaluronic capsule
    • does strep TSS have AB
    • no! no protective immunity as was seen in TSS
    • what is the pathogenesis of STSS
    • strep- cause invasive disease: necrotizing fasciatis, cellulitis, myositis
    • who gets TSS STSS
    • young adults (contrast to SSS which was infants)

      TSS- 15-35
      STSS- 20-50

      **young nad old untreated will likely die due to infecion
    • what predisposes ppl to staph TSS
    • s aureus cellulitis
      influenza
      sinisutis
      tracheitis
      IV drug use
      HIV
      post op
      gynecological infection
    • what predisposes to strep TSS
    • type II necrotizing fascitis

      strep myositis
    • how can you dx TSS caused by staph aures
    • fever, rash, shock/hypotension,

      **desquamation of palms/soles 1-2 weeks later
    • which disease has desquamation of palms and soles
    • TSS cause by staph aureus
    • do pts with TSS get HTN or hypotension
    • hypotension! also orthostatic syncope
    • what does it mean that there is multi system involvement with TSS infection
    • 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
    • what does the lab workup for TSS look like
    • negative!

      **can have S aureus in blood
      **serology for RMSF, leptospirosis, measles
    • what is the criteria for probable and confirmed cases of TSS
    • Probable: meets lab and 4/5 clinical manifestations

      Confirmed: meets lab criteria. 5/5 criteria. AND desquamation (palms/soles)
    • in STSS do you have HTN or hypotension, waht about multisystem involvement
    • HTN- like TSS

      also multisystem involvement but 2 or more (TSS was 3 or more)
    • what are the systems involved with strep STSS
    • 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
    • what are the labs associated with STSS
    • isolation of group A streptococcus
    • what does the dx of probable and confirmed cases of STSS
    • 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
    • whats the tx for TSS/STSS
    • O2
      IV fluids
      IVIG- neutralize TSS toxin
      AB- TSS: staph aureus- clindamcin, vancomycin
      STSS- strep pyogenes: clindamycin