Chapter 152- Gram Positive Infections Associated With Toxin Production Flashcards
Generalized exanthematous disease consisting of cutaneous tenderness and widespread superficial blistering and denudation
Staphylococcal scalded skin syndrome
Matching type
- Staphylococcal scalded skin syndrome
- Bullous impetigo
- Toxic shock syndrome (menstrual)
- Toxic shock syndrome (nonmenstrual)
- Scarlet fever
A. ETa B. ETb C. Tsst1 D. SPEa E. SEA to SEC
B A C D and E D
Serine proteases that bind to cell adhesion molecule desmoglein 1
Exfoliatin
Cleavage of desmoglein 1 results in epidermolysis between ____
Stratum spinosum and stratum granulosum
10% of all pediatric skin problems
Impetigo
Risk factors for development of exfoliative toxins in adults (3)
- Compromised immune response allowing for growth of S. Aureus
- Impaired toxin neutralizing antibodies
- Renal insufficiency
(2) accentuation is often noted in SSSS
Periorificial and flexural
Difference of SSSS and TEN (2)
Age distribution
Hpx findings
Major complication of SSSS
Serious fluid and electrolyte imbalance
Adult mortality is higher in SSSS.
True or False
True
Pediatric (2%)
Adult (10%)
Recognition of superantigens is not MHC restricted.
True or False
True
Superantigens lead to a massive release of cytokines
TNF alpha
IL1
IL6
Responsible for capillary leak syndrome
Cytokine storm
Examples of superantigens (3)
TSST1
SEA to SEC
SPEA SPEC
Inflammatry response characterized by fever, rash, hypotension, multiorgan involvement
Toxic Shock Syndrome
MC Staphylococcal toxin associated with TSS
TSST1
50% of nonmenstrual TSS
SEB and SEC
Case definition of Staphylococcal Toxic Shock Syndrome Clinical criteria (5)
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)
Case definition of Staphylococcal Toxic Shock Syndrome
Lab Criteria
Blood, throat, CSF positive for S. Aureus
Rise in titer in antibody tests for RMSF, leptospirosis, measles
Blood cultures are positive in ___% with stretococcal TSS in contrast to only ___% of patients with Staphylococcal TSS
50%
10%
Very young, very elderly, diabetic, or immunocompromised patients would be more susceptible to streptococcal TSS
True or False
True
Due to increasing amounts of MRSA in the community, ___ is recommended for TSS
Vancomycin
IVIg is used in severe or recalcitrant cases of TSS but is contraindicated in
Previous hypersensitivity to IgA
Women who had TSS should avoid using tampons to prevent reinfection.
True or False
True
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
Recalcitrant erythematous desquamating disorder (REDD)
Syndrome characterized by exudative pharyngitis, fever, scarlatiniform rash
Pyrogenic exotoxin producing group A Streptococcus
Sequela of streptococcal scarlet fever (2)
Renal failure
Rheumatic fever
Most streptococcal isolates causing scarlet fever express less virulent SPEB and SPEC.
True or False
True
Exanthem more intense around skinfolds and lines of confluent petechiae resulting from increased capilarry fragility
Pastia sign
Petechiae and puntate red macules are seen on soft palate and uvula
Forchheimer spots
White coated tongue through which the red and edematous papillae project
White strawberry tongue
Tongue desquamates resulting in a red tongue with prominent papilla
Red strawberry tongue
Incomplete form of SSSS
Staphylococcal scarlet fever
SEA shows significant protein sequence homology with SPEA.
True or False
False, SEB
Striking diffuse macular perineal erythema that occurs within 24-48 hours after pharyngitis with toxin producing Grp A Streptococcus or S. Aureus
Recurrent toxin mediated perineal erythema
Fever, hypotension, and other systemic signs are present in recurrent toxin mediated perineal erythema.
True or False
False, absent
Association of guttate psoriasis with ___ expressing group A Streptococcus with T cell receptor B VB pattern in skin lesions and in perilesional skin.
SPEC
Staphylococcal toxin which triggers mast cell degranulation in AD
Delta toxin
High levels of ___ are found on clinically impetiginized atopic skin which acts on TLR2 and PAF receptor
Lipoteichoic acid
S. Aureus infection correlates with CTCL severity.
True or False
True
Superantigen such as TSST 1 has been proven to cause CTCL.
True or Falsse
False, only worsens disease activity
Differences of staphylococcal scarlet fever from streptococcal scarlet fever (2)
Very tender
No pharyngitis has localized nidus of infection
