23 - 152 - GRAM-POSITIVE INFECTIONS ASSOCIATED WITH TOXIN PRODUCTION

Question 1

What toxins can cause bullous impetigo and staphylococcal scalded skin syndrome?

Answer 1

Exfoliatin Type A (ETA) and ETB

Question 2

Question 3

Toxin that causes toxic shock syndrome (menstrual»nonmenstrual)

Answer 3

Toxic shock syndrome toxin 1 (TSST-1)

Question 4

Toxins that can cause scarlet fever

Answer 4

Streptococcal pyrogenic exotoxins A and C ( SPEA, SPEC)

Question 5

The epidermolysis in SSSS usually occur where?

Answer 5

between the stratum spinosum and granulosum

Question 6

T/F. Nikolsky sign is positive in SSSS

Answer 6

True

Question 7

2 forms of exfoliatin-mediated disease:

Answer 7

localized bullous impetigo and systemic SSSS

Question 8

In both bullous impetigo and SSSS, the intraepidermal cleavage induced by the epidermolytic toxin occurs within or just below the stratum __________.

Answer 8

granulosum

Question 9

Major complications of SSSS

Answer 9

serious fluid and electrolyte disturbances

Question 10

The most common staphylococcal toxin associated with TSS is ________ and is the predominant toxin associated with menstrual-associated cases.

Answer 10

TSS toxin-1 (TSST-1)

Question 11

Clinical manifestations of toxic shock syndrome

Answer 11

The symptoms of TSS begin with acute onset of fever, sore throat, and myalgia. Diarrhea is common, and vomiting may also occur. The rash is most often a macular erythema but a scarlatiniform type can sometimes be seen. The eruption usually begins on the trunk and spreads to the extremities, and can involve palms and soles. Especially if the patient is hypotensive, the eruption tends to be more prominent on the trunk than extremities. Symptoms of hypotension include orthostatic dizziness, fainting, and overt shock. Nonpurulent conjunctival hyperemia, pharyngeal inflammation and strawberry tongue (see section “Scarlet Fever”) are invariably present. Signs of decreased mentation can also occur. The rash will desquamate within 1 to 2 weeks after beginning.

Question 12

Major criteria of Staphylococcal Toxic Shock Syndrome

Answer 12

Question 13

streptococcal TSS has been well-described as a complication of what viral illnesses?

Answer 13

Varicella and Influenza A

Question 14

T/F. A patient with signs of TSS and a localized cellulitis should suggest STREPTOCOCCAL TSS, as soft-tissue infections are not usually seen with STAPHYLOCOCCAL TSS.

Answer 14

TRUE

Question 15

how can you differentiate kawasaki from toxic shock syndrome since they may have similar clinical findings, including swelling of extremities and desquamation of palms and soles during convalescence?

Answer 15

Kawasaki syndrome differs in that the course of fever is prolonged and diarrhea and hypotension are absent.

Question 16

Clinical findings of recalcitrant erythematous, desquamating disorder (REDD)

Answer 16

fever and hypotension

The rash of REDD consists of diffuse macular erythema with delayed desquamation. Other findings in common with TSS include ocular and oral mucosal injection and strawberry tongue.

Question 17

Scarlet fever is a syndrome characterized by

Answer 17

exudative pharyngitis, fever, and scarlatiniform rash

Question 18

Clinical manifestations of streptococcal scarlet fever

Answer 18

Approximately 12 hours to 5 days after exposure, an abrupt prodrome consisting of pharyngitis, headache, vomiting, abdominal pain, and fever develops. The rash appears 1 to 2 days after onset of the illness, first on the neck and then extending to the trunk and extremities, although sparing the palms and soles.

The exanthem texture is usually coarse like fine-grade sandpaper, and the erythema blanches with pressure. The skin can be mildly pruritic, but usually is not painful.

Question 19

In streptococcal scarlet fever, A few days following generalization of the exanthem, it becomes more intense around skinfolds and lines of confluent petechiae resulting from increased capillary fragility can be seen.

What do you call this sign?

Answer 19

Pastia sign

Question 20

In strep scarlet fever, The generalized exanthem begins to fade _______ days after onset and a desquamative phase begins, usually starting with the face. Peeling from the palms and fingers and sometimes soles occurs approximately a week later and can last for as long as 1 month.

Answer 20

3 to 4 days

Question 21

Oral findings of streptococcal scarlet fever include

Answer 21

edematous, erythematous tonsils sometimes covered with a yellow, gray, or white exudate and tender anterior cervical lymphadenopathy is common

Question 22

What do you call the Petechiae and punctuate red macules are seen on the soft palate and uvula seen in strep scarlet fever?

Answer 22

Forchheimer spots

Question 23

Characteristic changes of the tongue in strep scarlet fever

Answer 23

During the first 2 days of the disease, the tongue has a white coat through which the red and edematous papillae project (white strawberry tongue). After 2 days, the tongue desquamates resulting in a red tongue with prominent papillae (red strawberry tongue).

Question 24

How can you differentiate Scarlet fever induced by staphylococci from those caused by strep?

Answer 24

LACK OF PHARYNGITIS

Question 25

How can you differentiate kawasaki from Staphylococcal scarlet fever?

Answer 25

Although Kawasaki syndrome has many similar clinical findings, including mucosal involvement (eg, strawberry tongue), and swelling of extremities and desquamation of palms and soles during convalescence, Kawasaki syndrome differs in that the course of fever is prolonged and cultures would be expected to be negative.

Question 26

What clues should you look for to differentiate scarlet fever caused by staph and strep

Answer 26

Scarlet fever from group A Streptococcus can usually be differentiated from that induced by S. aureus as the usual nidus of infection in streptococcal scarlet fever is from a pharyngitis whereas the staphylococcal variant usually has its infectious nidus in the skin.