Chapter 152- Gram Positive Infections Associated With Toxin Production

Question 1

Generalized exanthematous disease consisting of cutaneous tenderness and widespread superficial blistering and denudation

Answer 1

Staphylococcal scalded skin syndrome

Question 2

Matching type

1. Staphylococcal scalded skin syndrome
2. Bullous impetigo
3. Toxic shock syndrome (menstrual)
4. Toxic shock syndrome (nonmenstrual)
5. Scarlet fever

A. ETa
B. ETb
C. Tsst1
D. SPEa
E. SEA to SEC

Answer 2

B
A
C
D and E
D

Question 3

Serine proteases that bind to cell adhesion molecule desmoglein 1

Answer 3

Exfoliatin

Question 4

Cleavage of desmoglein 1 results in epidermolysis between ____

Answer 4

Stratum spinosum and stratum granulosum

Question 5

10% of all pediatric skin problems

Answer 5

Impetigo

Question 6

Risk factors for development of exfoliative toxins in adults (3)

Answer 6

1. Compromised immune response allowing for growth of S. Aureus
2. Impaired toxin neutralizing antibodies
3. Renal insufficiency

Question 7

(2) accentuation is often noted in SSSS

Answer 7

Periorificial and flexural

Question 8

Difference of SSSS and TEN (2)

Answer 8

Age distribution

Hpx findings

Question 9

Major complication of SSSS

Answer 9

Serious fluid and electrolyte imbalance

Question 10

Adult mortality is higher in SSSS.

True or False

Answer 10

True
Pediatric (2%)
Adult (10%)

Question 11

Recognition of superantigens is not MHC restricted.

True or False

Answer 11

True

Question 12

Superantigens lead to a massive release of cytokines

Answer 12

TNF alpha
IL1
IL6

Question 13

Responsible for capillary leak syndrome

Answer 13

Cytokine storm

Question 14

Examples of superantigens (3)

Answer 14

TSST1
SEA to SEC
SPEA SPEC

Question 15

Inflammatry response characterized by fever, rash, hypotension, multiorgan involvement

Answer 15

Toxic Shock Syndrome

Question 16

MC Staphylococcal toxin associated with TSS

Answer 16

TSST1

Question 17

50% of nonmenstrual TSS

Answer 17

SEB and SEC

Question 18

Case definition of Staphylococcal Toxic Shock Syndrome
Clinical criteria (5)

Answer 18

Clinical criteria
Fever (>38.9)
Rash
Desquamation
Hypotension (<95mmHg adults, <5th percentile for children <16 y/o)
Multisystem involvement
(3 or more: GI, Muscular, Mucous membrane, Renal, Hepatic, Hematologic, CNS)

Question 19

Case definition of Staphylococcal Toxic Shock Syndrome

Lab Criteria

Answer 19

Blood, throat, CSF positive for S. Aureus

Rise in titer in antibody tests for RMSF, leptospirosis, measles

Question 20

Blood cultures are positive in ___% with stretococcal TSS in contrast to only ___% of patients with Staphylococcal TSS

Answer 20

50%

10%

Question 21

Very young, very elderly, diabetic, or immunocompromised patients would be more susceptible to streptococcal TSS
True or False

Answer 21

True

Question 22

Due to increasing amounts of MRSA in the community, ___ is recommended for TSS

Answer 22

Vancomycin

Question 23

IVIg is used in severe or recalcitrant cases of TSS but is contraindicated in

Answer 23

Previous hypersensitivity to IgA

Question 24

Women who had TSS should avoid using tampons to prevent reinfection.
True or False

Answer 24

True

Question 25

Presents with fever, hypotension, diffuse macular erythema with delayed desquamation with oral, mucosal injection and strawberry tongue but in contrast to TSS it’s prolonged

Answer 25

Recalcitrant erythematous desquamating disorder (REDD)

Question 26

Syndrome characterized by exudative pharyngitis, fever, scarlatiniform rash

Answer 26

Pyrogenic exotoxin producing group A Streptococcus

Question 27

Sequela of streptococcal scarlet fever (2)

Answer 27

Renal failure

Rheumatic fever

Question 28

Most streptococcal isolates causing scarlet fever express less virulent SPEB and SPEC.
True or False

Answer 28

True

Question 29

Exanthem more intense around skinfolds and lines of confluent petechiae resulting from increased capilarry fragility

Answer 29

Pastia sign

Question 30

Petechiae and puntate red macules are seen on soft palate and uvula

Answer 30

Forchheimer spots

Question 31

White coated tongue through which the red and edematous papillae project

Answer 31

White strawberry tongue

Question 32

Tongue desquamates resulting in a red tongue with prominent papilla

Answer 32

Red strawberry tongue

Question 33

Incomplete form of SSSS

Answer 33

Staphylococcal scarlet fever

Question 34

SEA shows significant protein sequence homology with SPEA.

True or False

Answer 34

False, SEB

Question 35

Striking diffuse macular perineal erythema that occurs within 24-48 hours after pharyngitis with toxin producing Grp A Streptococcus or S. Aureus

Answer 35

Recurrent toxin mediated perineal erythema

Question 36

Fever, hypotension, and other systemic signs are present in recurrent toxin mediated perineal erythema.
True or False

Answer 36

False, absent

Question 37

Association of guttate psoriasis with ___ expressing group A Streptococcus with T cell receptor B VB pattern in skin lesions and in perilesional skin.

Answer 37

SPEC

Question 38

Staphylococcal toxin which triggers mast cell degranulation in AD

Answer 38

Delta toxin

Question 39

High levels of ___ are found on clinically impetiginized atopic skin which acts on TLR2 and PAF receptor

Answer 39

Lipoteichoic acid

Question 40

S. Aureus infection correlates with CTCL severity.

True or False

Answer 40

True

Question 41

Superantigen such as TSST 1 has been proven to cause CTCL.

True or Falsse

Answer 41

False, only worsens disease activity

Question 42

Differences of staphylococcal scarlet fever from streptococcal scarlet fever (2)

Answer 42

Very tender

No pharyngitis has localized nidus of infection