Micro Winter 13 Toxic Syndromes Flash Cards

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Title:	Micro Winter 13 Toxic Syndromes
Description:	micro
Number of Cards:	48
Save Count:	0
Author:	jessica.prentice7
Created:	2012-01-02
Tags:	micro
Private	No

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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