Shock

Question 1

Superantigen in Toxic Shock

Answer 1

Most often due to Staph aureus or Strep pyogenes.

Occurs due to excessive activation to T-cells and antigen-presenting cells = cytokine storm! BOOM!

Question 2

Two Types of Staphyloxoccal toxic shock syndrome

Answer 2

Menstrual (TTST-1)

Non-Menstrual (enterotoxins A-E) - post surgical, skin infection, abscess wounds. (not usually bacteremic)

Question 3

Describe Streptococcal Toxic Shock Syndrome

Answer 3

usually it starts as a fairly obvious soft tissue infection (necrotizing fasciitis). Patients have bacteremia. Severe pain at infection site.

Question 4

Treatment of Toxic Shock Syndrome

Answer 4

IV fluids, clean of infection site, antibiotics (vancomycin if MRSA, nafcillin if MSSA,) + clindamycin (blocks toxin production), IVIG therapy if needed.

Question 5

Endotoxin

Answer 5

Usually refers to lipopolysaccharides (LPS) of bacteria. This binds and results in the production of cytokines. Excessive release of TNF and IL-1 cause shock.

Question 6

What is LPS recognized by?

Answer 6

Toll like receptor - 4 (TLR4) a pattern recognition receptor. They are supposed to help for early dectection of bacterial infection and rapid engagement of immune response.

Question 7

Meningococcemia

caused by what pathogen?

Answer 7

VERY FAST –> kills scary quick.

usually caused by Neisseria meningitides - gram (-), aerobic, diplococcic.

Question 8

Treatment of meningococcemia

Answer 8

Antibiotics for 10-14 days

• -penicillin
• -3rd gen cephalosporins - ceftriaxone (especially when there is penicillin resistance)
• -Chloramphenical