Anästhesiol Intensivmed Notfallmed Schmerzther 2006; 41(11): E 24-E 29
DOI: 10.1055/s-2006-958850
Originalie

© Georg Thieme Verlag Stuttgart · New York

Toxisches Streptokokken Schock Syndrom in Verbindung mit serologisch nachgewiesenen Autoantikörpern - Streptococcal Toxic Shock-like Syndrome Associated with Detectable Autoantibodies

H. Rüffert1 , T. Albert1 , C. Rudolph1 , M. Wehner11 , C. Deutrich11 , R. Schaumann2 , L. Schütz3 , D. Olthoff1
  • 1Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig AöR
  • 2Institut für Mikrobiologie, Universität Leipzig
  • 3Chirurgische Klinik und Poliklinik I, Universitätsklinikum Leipzig AöR
Further Information

Publication History

Publication Date:
07 December 2006 (online)

Zusammenfassung

Im vorliegenden Fall möchten wir über den schweren Verlauf eines Toxischen Streptokokken Schock Syndroms (STSLS) berichten, dessen Diagnosesicherung und kausale Therapieeinleitung maßgeblich durch den Nachweis von serologischen Autoantikörpern kompliziert und beeinflusst wurde. Neben der Darstellung der klinischen und paraklinischen Befunde sollen Differenzialdiagnosen mit den entsprechenden Interventionsstrategien vorgestellt und diskutiert werden.

Abstract

We report on the severe course of a Streptococcal Toxic Shocklike Syndrome (STSLS). The initial diagnosis as well as the causal therapeutic approaches were complicated and prolongated definitely by the serological detection of auto-antibodies. Besides the presentation of clinical and paraclinical findings the report responds to relevant differential diagnoses and the corresponding strategies of therapeutic intervention.

Literatur

  • 1 Willoughby R, Greenberg RN. The toxic shock syndrome and streptococcal pyrogenic exotoxins.  Ann Intern Med. 1983;  98 559
  • 2 Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeill EM, Englender SJ. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study.  JAMA. 1993;  269 384-389
  • 3 Stromberg A, Romanus V, Burman LG. Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study.  J Infect Dis. 1991;  164 595-598
  • 4 Davies HD, McGeer A, Schwartz B, Green K, Cann D, Simor AE, Low DE. Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group.  N Engl J Med. 1996;  335 547-554
  • 5 Eriksson BK, Andersson J, Holm SE, Norgren M. Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome.  Clin Infect Dis. 1998;  27 1428-1436
  • 6 Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A.  N Engl J Med. 1989;  321 1-7
  • 7 The Working Group on Severe Streptococcal Infections . Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition.  JAMA. 1993;  269 390-391
  • 8 Chomarat M, Chapuis C, Lepape A, Bernard F. Two cases of severe infection with beta-haemolytic group A streptococci associated with a Rüffert H et al. Toxisches Streptokokken Schock Syndrom.  Eur J Clin Microbiol Infect Dis. 1990;  9 901-903
  • 9 Holm SE, Norrby A, Bergholm AM, Norgren M. Aspects of pathogenesis of serious group A streptococcal infections in Sweden, 1988-1989.  J Infect Dis. 1992;  166 31-37
  • 10 Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids.  Rev Infect Dis. 1989;  41 954-963
  • 11 Chikkamuniyappa S. Streptococcal toxic shock syndrome and sepsis manifesting in a patient with chronic rheumatoid arthritis.  Dermatol Online J. 2004;  10 7
  • 12 Stevens DL. Could nonsteroidal antiinflammatory drugs (NSAIDs) enhance the progression of bacterial infections to toxic shock syndrome?.  Clin Infect Dis. 1995;  21 977-980
  • 13 Hasty DL, Ofek I, Courtney HS, Doyle RJ. Multiple adhesins of streptococci.  Infect Immun. 1992;  60 2147-2152
  • 14 Hauser AR, Stevens DL, Kaplan EL, Schlievert PM. Molecular analysis of pyrogenic exotoxins from Streptococcus pyogenes isolates associated with toxic shock-like syndrome.  J Clin Microbiol. 1991;  29 1562-1567
  • 15 Henderson B, Poole S, Wilson M. Bacterial modulins: a novel class of virulence factors which cause host tissue pathology by inducing cytokine synthesis.  Microbiol Rev. 1996;  60 316-341
  • 16 Kotb M. Bacterial pyrogenic exotoxins as superantigens.  Clin Microbiol Rev. 1995;  8 411-426
  • 17 Alouf JE, Muller-Alouf H. Staphylococcal and streptococcal superantigens: molecular, biological and clinical aspects.  Int J Med Microbiol. 2003;  292 429-440
  • 18 Baker MD, Acharya KR. Superantigens: structure-function relationships.  Int J Med Microbiol. 2004;  293 529-537
  • 19 Stevens DL. Invasive group A streptococcus infections.  Clin Infect Dis. 1992;  14 2-11
  • 20 Broll R, Eckmann C, Kujath P, Bruch HP. Streptococcal toxic shock-like syndrome.  Chirurg. 1998;  69 806-812
  • 21 Eagle H. Experimental approach to the problem of treatment failure with penicillin. I. Group A streptococcal infection in mice.  Am J Med. 1952;  13 389-399
  • 22 Stevens DL, Yan S, Bryant AE. Penicillin-binding protein expression at different growth stages determines penicillin efficacy in vitro and in vivo: an explanation for the inoculum effect.  J Infect Dis. 1993;  167 1401-1405
  • 23 Gemmell CG, Peterson PK, Schmeling D, Kim Y, Mathews J, Wannamaker L, Quie PG. Potentiation of opsonization and phagocytosis of Streptococcus pyogenes following growth in the presence of clindamycin.  J Clin Invest. 1981;  67 1249-1256
  • 24 Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection.  Pediatr Infect Dis J. 1999;  18 1096-1100
  • 25 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early Goal-Directed Therapy Collaborative Group. . Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001;  345 1368-1377
  • 26 Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher Jr CJ. Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis.  N Engl J Med. 2001;  344 699-709
  • 27 Baxter F, McChesney J. Severe group A streptococcal infection and streptococcal toxic shock syndrome.  Can J Anaesth. 2000;  47 1129-1140
  • 28 Norrby-Teglund A, Kaul R, Low DE, McGeer A, Andersson J, Andersson U, Kotb M. Evidence for the presence of streptococcal-superantigenneutralizing antibodies in normal polyspecific immunoglobulin G.  Infect Immun. 1996;  64 5395-5398
  • 29 Norrby-Teglund A, Kaul R, Low DE, McGeer A, Newton DW, Andersson J, Andersson U, Kotb M. Plasma from patients with severe invasive group A streptococcal infections treated with normal polyspecific IgG inhibits streptococcal superantigen-induced T cell proliferation and cytokine production.  J Immunol. 1996;  156 3057-3064
  • 30 Sontheimer RD, Provost TT. Cutaneous manifestation of lupus erythematosus.  In: Wallace DJ, Hahn BH (Hrsg). Dubious lupus erythematosus.  Baltimore: Williams and Wilkins. 1997;  569-623
  • 31 Lesavre P. The diagnostic and prognostic significance of ANCA.  Ren Fail. 1996;  18 803-812
  • 32 Tomita H, Yamada M, Sekigawa I, Yoshiike T, Iida N, Hashimoto H. Systemic lupus erythematosus-like autoimmune abnormalities induced by bacterial infection.  Clin Exp Rheumatol. 2003;  21 497-499
  • 33 Krieg AM. CpG DNA: a pathogenic factor in systemic lupus erythematosus?.  J Clin Immunol. 1995;  15 284-292
  • 34 Okada M, Ogasawara H, Kaneko H, Hishikawa T, Sekigawa I, Hashimoto H, Maruyama N, Kaneko Y, Yamamoto N. Role of DNA methylation in transcription of human endogenous retrovirus in the pathogenesis of systemic lupus erythematosus.  J Rheumatol. 2002;  29 1678-1682
  • 35 Mege JL, Escallier JC, Capo C, Bongrand P, Velut JG, Quiles N, Soubeyrand J, Durand JM. Anti-neutrophil cytoplasmic antibodies (ANCA) and infection.  Adv Exp Med Biol. 1993;  336 353-356

Korrespondenzadresse

PD Dr. med. habil. Henrik Rüffert

Klinik für Anästhesiologie und Intensivtherapie Universitätsklinikum

Leipzig AöR, Liebigstraße 20, 04103 Leipzig

Email: henrik.rueffert@medizin.uni-leipzig.de

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