A 16-year-old boy presents to the emergency center with a 2-day history of an abscess with spreadin

Discussion in 'MRCPCH forum' started by samuel, Sep 19, 2014.

  1. samuel

    samuel New Member

    A 16-year-old boy presents to the emergency center with a 2-day history
    of an abscess with spreading cellulitis. While in the emergency center, he
    develops a high fever, hypotension, and vomiting with diarrhea. On exami-nation you note a diffuse erythematous macular rash, injected conjunctiva
    and oral mucosa, and a strawberry tongue. He is not as alert as when he first
    arrived. This rapidly progressive symptom constellation is likely caused by
    which of the following disease processes?
    a. Kawasaki disease
    b. TSST-1–secreting S aureus
    c. Shiga toxin–secreting Escherichia coli
    d. α-Toxin–secreting Clostridium perfringens
    e. Neurotoxin-secreting Clostridium tetani
  2. samuel

    samuel New Member

    The ans is B
    Toxic shock syndrome (TSS) is usually caused by S aureus, but a similar syndrome (sometimes called toxic shock-like syndrome [TSLS]) may be caused by Streptococcussp. The strains of S aureusresponsible secrete toxic shock syndrome toxin 1 (TSST-1), and can cause “menstrual” TSS (associated with intravaginal devices like tampons, diaphragms, and contraceptive sponges) or “nonmenstrual” TSS associated with pneumonia, skin infection (as in this patient), bacteremia, or osteomyelitis. The diagnosis is made clinically, and the case description is typical. Treatment includes blood cultures followed by aggressive fluid resuscitation and antibiotics targeting S aureus. Kawasaki is not typically seen in adolescents, and is not as rapidly progressive. Shiga toxin producingstrains
    ofE coliandShigellaare usually associated with hemolytic-uremic syndrome.
    Clostridium perfringenscan secrete several toxins; one is an α-toxinthat causes hemolysis, platelet lysis, increased vascular permeability, and hepatotoxicity. The neurotoxin secreted by C tetanicauses tetanus.

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