Polymyxin-B immobilized column-direct hemoperfusion for adolescent toxic shock syndrome.

Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP. PMX-DHP has been widely used for the treatment of sepsis to remove circulating endotoxins produced by Gram-negative bacteria, but beneficial effects have also been reported for Gram-positive bacterial infection. To our knowledge, this is the first report on PMX-DHP for TSS in an adolescent patient, and we propose that PMX-DHP could be a new treatment strategy for severe TSS in children as well.

[Septic shock in a renal transplanted patient after consumption of uncooked pork meat]. / Septischer Schock bei einem nierentransplantierten Patienten nach Genuss von rohem Schweinefleisch.

Salmonellosis caused by Salmonella enteritidis is an acute and in most cases zoonotic disease, but chronic human carriers are also known. Mostly, affected persons recover without treatment, but severe complications occur occasionally. For the first time we report a case of probably food-borne invasive Salmonella enteritidis infection with septic shock in a patient with Tacrolimus treatment, 13 years after renal transplantation, probably acquired by uncooked ground pork meat.

[Fatal sepsis due to capnocytophaga canimorsus after dog bite]. / Letal verlaufende Capnocytophaga-canimorsus-Sepsis nach Hundebiss.

A 56-year-old man was bitten by a dog. 8 days later he was admitted to a hospital because of severe deterioration of his clinical situation. He developed the clinical picture of fulminant sepsis. In spite of aggressive intensive care therapy the patient died 24 hours later. Capnocytophaga canimorsus was identified from initial blood cultures. This gram-negative rod is part of the normal oral flora of dogs and cats. It can be spread to humans by bites, licking or scratches and causes severe infections, especially in persons with special risk factors (splenectomy, alcoholism). The mortality rate in the published cases is 25-30%.

[Maternal-fetal staphylococcal toxic shock syndrome with chorioamniotitis]. / Choc toxique staphylococcique maternofoetal sur chorioamniotite.

We report a rare case of mother-infant pair with Staphylococcal Toxic Shock Syndrome (TSS). A term neonate was born by caesarean section for maternal septic syndrome during per-partum. He presented with respiratory distress complicated by pulmonary hypertension, skin rash, and multiple organ system involvement. Staphylococcus aureus was isolated from placenta, surface swabs and gastric aspirate. He received adapted antibiotics, respiratory support by high frequency ventilation and NO. The mother had shock, skin rash and inflammatory syndrome. Outcome was good in both cases. The isolate produced enterotoxin C and L. Shock, exanthematous disease and multi-organ involvement complicating a staphylococcal infection in neonate must lead to suspect a TSS.

A parent as a vector of Salmonella brandenburg nosocomial infection in a neonatal intensive care unit.

A newborn baby was admitted to the Neonatal Intensive Care Unit (NICU) of St Germain en Laye Hospital (France) because of premature birth. On day 12, he contracted gastroenteritis due to Salmonella brandenbourg. The salmonellosis led to a septic shock syndrome with a brief cardiopulmonary arrest. He was treated with intravenous ceftriaxone and gentamicin, and the evolution was favorable. Microbiological investigations revealed that the mother was the vector for this nosocomial infection. S. brandenbourg was isolated from the feces of the baby, despite recent recommendations on managing stool specimens from patients hospitalized for more than three days: according to these recommendations, these stools should be processed for viruses and Clostridium difficile toxin only.

A family cluster of streptococcal toxic shock syndrome in children: clinical implication and epidemiological investigation.

BACKGROUND: Most invasive group A streptococcal (GAS) disease occurs sporadically. Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults. We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation. PATIENTS AND METHODS: During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease. Cases 2 and 3 had GAS isolated from blood culture. Case 2 was fatal. Pharyngeal culture survey of the family members and schoolchildren was conducted. Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined. RESULTS: One of 15 family members sampled-the sister of the index case-and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures. Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype. CONCLUSION: We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact. Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur.

[Studies on human streptococcal infectious syndrome caused by infected pigs].

OBJECTIVES: To demonstrate the clinical manifestations of S. suis infectious syndrome; to study the characteristics of causative organism and its source. METHODS: 25 cases of unknown causes of food poisoning were identified in the central area of Jiangsu province, China in July 1998. Biological specimens was collected in some patients, and the causative organism was isolated using a number of different culture medium. Isolated organisms were identified by serum antibody tests, API biochemical tests, drug sensitivity tests and animal model experiments. The human born strains and the pig born strains were compared by RAPD technique. Epidemiological methods were applied to trace the source of causative organisms. RESULTS: Cases were clinically categorized into two types: Streptococcal toxic shock syndrome (STSS) and streptococcal meningitis syndrome (SMS). Three strains of streptococci were isolated respectively from the blood and cerebrospinal fluid of 6 cases. All these 6 strains were confirmed to be S. suis type 2 by culture characteristics, morphology, biochemical characteristics, serum antibody tests and fatty acid profile analysis. Animal model experiment showed that these strains were sensitive to rabbits and pigs, but not to rats. RAPD fingerprint test revealed an identity between human born and pig born strains. CONCLUSIONS: The aetiological agent of these human cases was S. suis type 2. Human cases were contracted by direct contact with the infected pigs or the corpse of infected pigs.

Streptococcal toxic shock syndrome in two patients infected by a colonized surgeon.

The incidence of severe invasive infections caused by Streptococcus pyogenes, a group A streptococcus (GAS), has increased in the past 10 years. Most cases occur outside of the hospital setting. We report on two patients with nosocomial streptococcal toxic shock syndrome (StrepTSS). In patient 1 the syndrome was associated with the development of necrotizing fasciitis following inguinal hernia repair. Patient 2 suffered from StrepTSS shortly after receiving a tetanus vaccine in her left deltoid. Epidemiologic investigations of these cases, which were noted within 48 hours of each other, showed that the same surgeon performed the vaccination on patient 2 after assisting a colleague during the hernia repair procedure on patient 1. He was found to be a nasal carrier of GAS. All GAS isolates from the patients and the surgeon were indistinguishable by pulsed field gel electrophoresis. PCR analysis demonstrated the presence of streptococcal pyogenic exotoxins A and F. All strains were of the T-1 serotype and possessed the gene for M-protein 1. This report demonstrates that a virulent strain of GAS may be spread by asymptomatically colonized medical personnel via the air route.

[A fatal case of streptococcal toxic shock-like syndrome probably caused by acupuncture].

A 41-year-old male received acupuncture in the right shoulder for the sake of arthralgia. Three days after acupuncture he was admitted due to severe epigastralgia. Erythematous change and swelling were observed around the right shoulder. A study by magnetic resonance showed an increased signal intensity in a portion of the right subscapular muscle. Four hours after admission he became hypotensive. The erythematous and necrotic change in the right shoulder skin rapidly spread. Excisional debridement in the right lateral chest wall was immediately done. However, the patient died one day after admission despite administration of a high-dose ampicillin and other supportive therapies. Bacteriological and histological examinations confirmed severe streptococcal myositis. This is a case report of toxic shock-like syndrome probably caused by acupuncture.

Transmission of Streptococcus pyogenes causing toxic shock-like syndrome among family members and confirmation by DNA macrorestriction analysis.

Streptococcus pyogenes can cause severe infections, such as toxic shock-like syndrome (TSLS). The transmission and pathogenesis of TSLS are poorly understood, and information is needed to develop prevention strategies. Four cases were identified in which the organism was transmitted among patients with TSLS and their family members. DNA macrorestriction endonuclease analysis using pulsed-field gel electrophoresis demonstrated the spread of S. pyogenes clones that caused TSLS among the family members. Although 14 persons related to the case-patients experienced only colonization or self-limited disease, 3 developed invasive infections (pneumonia, severe pharyngitis requiring hospitalization, and puerperal sepsis). These findings indicate that antimicrobial prophylaxis for close contacts of patients with TSLS should be considered and reinforce the need for further studies on epidemic control of TSLS.

Streptococcal toxic shock syndrome in a postpartum woman. Case report and review of the literature.

A case of streptococcal toxic shock syndrome in a 29-year-old postpartum woman is described. The patient presented with hypotension, coagulation defects, adult respiratory distress syndrome and scarlet exanthema as a complication of hemolytic group A streptococcal endometritis. One hundred and twenty-two other cases of streptococcal toxic shock syndrome in the literature are reviewed and the criteria of the syndrome discussed. Streptococcal toxic shock syndrome seems to be increasing along with more frequent invasive streptococcal infections in several countries. It is therefore important to recognize and treat the infection as early as possible to minimize the risk of mortality.

Dynamics of emergence.

I have touched briefly here on the complex matrix of social, economic, political, and ecologic factors that have played a major role in the emergence of microbial diseases. But beyond these factors that contribute to the emergence of new infectious diseases, we must also recognize changes in microbial agents, human populations, insect vectors, and the ecologic relationships among them. Microbes and vectors swim in the evolutionary stream and they swim much faster than we do. Bacteria reproduce every 30 min; for them a millennium is compressed into a fortnight. Microbes were here, learning every trick for survival, 2 billion years before humans arrived, and it is likely that they will be here 2 billion years after we depart. Furthermore, science cannot halt the future occurrence of new microbes, which emerge from the evolutionary stream as a consequence of genetic events and selective pressures that favor the new over the old. It is nature's way. For all of these reasons, old and new infections will occur in the future as they have in the past. Surveillance efforts, both in the United States and other regions of the world, will be needed to blunt the emergence of such infections and to forestall epidemics and pandemics. But surveillance alone cannot detect the unexpected emergence of future microbes or prepare the defense against them. That will require a broadly based research effort to devise new methods of diagnosis, treatment, and prevention. We must swim with the microbes and study their survival and adaptation to new habitats.(ABSTRACT TRUNCATED AT 250 WORDS)

Transmission of 'toxic strep' syndrome from an infected child to a firefighter during CPR.

Several cases of a toxic shocklike syndrome have been reported in the United States during the past five years in association with Streptococcus pyogenes infection. We report a case of a firefighter exposed during attempted CPR to the secretions of an S pyogenes-infected child. The firefighter developed an infection of the hand and subsequent febrile illness with hypotension, erythematous rash, renal failure, and hypocalcemia. Bacterial isolates of blood and cerebrospinal fluid from the deceased child were identical in type and exotoxin production with isolates grown from the hand wound of the firefighter. This is the first reported case of documented transmission of S pyogenes, causing a toxic shocklike syndrome in an emergency medical technician.

[Transfusion and transmission of infectious and parasitic diseases excluding AIDS and viral hepatitis]. / Transfusion et transmission des maladies infectieuses et parasitaires à l'exclusion du SIDA et des hépatites virales.

Many viruses, bacteria or parasites can survive in stored blood for varying lengths of time. Recipients are therefore exposed to a risk which depends on the prevalence of pathogens in blood donor populations, the clinical and laboratory controls performed in blood transfusion centres and the efficiency of the patient's immune system. Beside the HIV and hepatitis viruses, transfusions may transmit the HTL virus in endemic areas or if the blood donor comes from one of these areas (e.g. the French West Indies), the CMV virus (but only in patients with weak immune defences) and some exotic viruses in specific regions. As regards bacterial agents, syphilis is prevented by blood storage at 4 degrees C for 72 hours and brucellosis remains a minor risk, but the very rare endotoxinic shock is severe and lethal in two-thirds of the cases. Infestation by parasites is common in certain areas, but it may occur in France after transfusion from blood donors coming from these areas; malaria transmitted by blood perfusion is a real problem. Drastic procedures of rejection of blood donors at risk, including examination and laboratory screening, must be applied and are effective in preventing these dangers. These procedures are well-known and are compulsory in France.

Nosocomial transmission of a strain of Staphylococcus aureus causing toxic shock syndrome.

A strain of Staphylococcus aureus producing toxic shock syndrome toxin-1 was repeatedly isolated from the nares of a neurosurgeon. This strain was identical to strains cultured from two of his patients who developed toxic shock syndrome after laminectomy. The relatedness of the isolates was shown by Southern blot hybridization analyses using chromosomal transposons as probes. This approach should be considered, in addition to standard bacteriologic techniques, as an effective method to analyze the relatedness of nosocomial isolates.