Postinfluenza Toxic concussion Synd...

Postinfluenza Toxic concussion Syndrome (*1)

In 1978 toxic stroke syndrome (TSS) was described as a multisystem illness capable of producing febrile affection hypotension, and rash, with eventual desquamation. [1] The syndrome was later associated with exotoxin-producing Staphyococcus aureus infection usually occurring in women in relation to tampon use. However, non-menstrual TS has occurr in a variety of other clinical sitations, including respiratory tract infections. There are three reports [2-4] documenting 11 cases in which an influenzalike illness was followed by way of S aureus respiratory tract infection complicated from TSS. These recently published accounts raise speculation that a syndrome of postinfluenza TS may be emerging. [4] The following report at hands the clinical features of as it is a case and highlights the importance of respiratory tract involvement in toxic clash syndrome.

CASE REPORT

A 19-year-old man with a four-day history of nonproductive cough sore throat, and nasal congestion instanted with acute deterioration characterized by way of a productive cough, dyspnea, diarrhea, myalgias, and disorientation. Physical examination revealed an erythematous macular rash across the extremities, chest, and abdomen; pharyngeal erythema with a strawberry tongue; bilateral conjunctival injection; family pressure 90/50 mm Hg, pulsation 150, respirations 30, and temperature 406[degrees]C The abnormal laboratory values included a white relations cell count of 26,000/cu mm proteinuria, calcium 75 mg/dL creatinine 17 mg/dL aspartate aminotransferase 84 U/L (10-37) alanine aminotransferase 72 U/L (12-39) lactate dehydrogenase 316 U/L (118-242) and creatine kinase 675 U/L (35-185) The arterial vital fluid gas levels on room air demonstrated [Posub2] 44 mm Hg; [Pcosub2] 25 mm Hg; and pH 753 The chest x-ray film showed a faint right lower lobe infiltrate (Fig 1) and minimal changes in the left lower lobe. rises of blood, CSF, urine, stool, and throat improvements were negative; purulent sputum produc a true growth of penicillin-resistent S aureus. Serologic studies were negative for Mycoplasma, Legionella, psittacosis, stubborn Mountain spotted fever, cytomegalovirus, adenovirus, influenza A and C and parainfluenza. Antiobidies to influenza B were not past nor future acutely at a titer of 1:128

The patient was admitted to the intensive care unit and started forward therapy with erythromcyin and nafcillin. He was adequately oxygenated forward 50 percent oxygen concentration delivered on face mask and received intravenous fluids, keeping his systolic children pressure above 100 mm Hg The symptoms and physical findings showed improvement within four days, and normalization of the laboratory data and chest x-ray film was seen by means of day 10 of hospitalization. Desquamation of skin through the whole extent of the palms and soles occurr during regaining appearing most prominently on the only (Fig. 2). He was discharged in beneficial health on day 12.

DISCUSSION

There is no diagnostic trial for toxic shock syndrome. Case definition requires the mien of specific clinical manifestations. The Center for Disease rule criteria [5,6] include fever, diffuse erythorderma with following desquamation, hypotension, and multisystem involvement. Additionally, descendants throat, and cerebrospinal fluid agricultures as well as serologic studies for hard Mountain spotted fever, leptospirosis, and rubeola should be negative if obtained. Positive TS toxin assays are not necessary for diagnosis. This case fulfills these criteria, including laboratory documentations of systemic illness with elevated creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase and thrombocytopenia.

Combining data from this patient and the 11 previously reported cases [2-4] of postinfluenza TS reveals the following points. The age range was five to 56 years (mean 24) with six males and six females. All had respiratory symptoms and eight of ten had evidence of pneumonia onward chest x-ray examination. couple died before hospitalization with no prior chest x-ray examination and their autopsy findings demonstrated tracheitis without pneumonia. [3] Therefore, eight of 12 (67 percent) had evidence of pneumonia. five of five experimented had positive cultures or serologies for influenza B Positive s aureus sputum cultures were seen in 11/11 as a spring of purulent tracheitis or pneumonitis. Nine of nine yielded positive TS toxin assays for either toxin-1 or enterotoxin B Desquamation, which is an unnecessary criterion for a confirmed case of TS if the patient dies within sum of two units weeks, occurred in seven of 12 (58 percent) The patients who did not display desquamation had died early in their clinical course, in the same manner that their findings may not now have developed. Specific therapeutic regimens were described in four of 12; all of these received antistaphylococcal antibiotics and three of four survived. Overall, fatal issue was reported in six (50 percent)

These cases appear to define a just discovered syndrome of postinfluenza TSS, although the recognition of this entity may have its origins in antiquity. In fact, before the first of that kind case was reported, Langmuir et al [78] theorized that the historic plague of Athens which began in 430 BC was proper to toxin-producing S aureus during an influenza epidemic. These authors have prompted the term "Thucydides syndrome" for this disease proces in honor of the Athenian general, Thucydides, who documented the meanings of the illness extensively. It is of interest that the change or reappearance of bacterial strains and their association with toxic syndrome is not unique to s aureus; rather, this phenomenon has been described greatest in quantity recently with group A streptococcal infections as well. [910]