Toxic shock
Last reviewed: 17.06.2018
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Toxic shock is extremely rare. But, despite this in most cases, it carries a serious risk to human health.
To develop this phenomenon, can quickly, and entail negative processes in various systems of organs, including the lungs, kidneys and liver.
Causes of toxic shock
The causes of toxic shock in most cases are associated with infection with bacteria. They produce toxins, which lead to the development of toxic shock. To date, they are quite common, but usually do not cause serious harm to the body. They can lead to the development of infections of the throat or skin. All this is easily eliminated and does not entail serious consequences. In rare cases, toxins enter the bloodstream and thus cause a strong immune response in people whose bodies do not fight them at all.
Streptococcal shock occurs during childbirth, influenza, chickenpox and surgery. Perhaps development against the backdrop of weak cuts, wounds or bruises. Even the most common bruises that can not break the integrity of the skin can become causal.
Staphylococcal toxic shock occurs after prolonged use of tampons or after a surgical procedure. Warn the development of this phenomenon in many cases is almost impossible.
[Pathogenesis of infectious toxic shock
The pathogenesis of infectious toxic shock - at the level of small vessels is characterized by the fact that a large number of toxins enter the circulatory system. They are allocated by bacteria-saprophytes. This phenomenon leads to a sharp release of adrenaline and other biologically active substances. They can cause a spasm of post-capillary venules and arterioles. The blood that circulates through the open arteriovenous shunts can not perform its direct function. Against this background, tissue ischemia and metabolic acidosis occur. Deterioration of circulation leads to the appearance of tissue hypoxia, because of oxygen deficiency anaerobic metabolism occurs.
At the level of organ systems, the pathogenesis of an infectious toxic shock manifests itself in the form of the deposition of blood in the capillaries and the release of its liquid part into the intercellular space. First there is a relative, and then absolute hypovolemia. It is possible to reduce renal perfusion. This leads to an excessive drop in glomerular filtration. Developing on this background, edema causes acute renal failure. Similar processes occur in the lungs. That's why toxic shock carries a considerable danger.
Symptoms of toxic shock
Symptoms of toxic shock develop rapidly and rapidly. And all this is so fleeting that within 2 days death may come.
The first signs of "disease" include extremely serious consequences. So, there are feelings that are similar to the flu. It starts with muscle pain, stomach cramps, headache and sore throat. Suddenly, the temperature can rise to 38.9. Vomiting and diarrhea are not excluded.
Over time, there are signs of shock. They are characterized by low blood pressure and heart palpitations. Often all this is accompanied by dizziness, loss of consciousness, nausea, vomiting or dysphoria and confusion of consciousness. It is possible that redness, which is similar to sunburn. It can appear in several parts of the body or in separate places. Basically it is armpits or in the groin. At the site of infection there is severe pain. Redness of the nasal passages and mouth is observed.
Other symptoms include: conjunctivitis, blood poisoning, skin tissue peeling and death of skin tissue. That is why toxic shock carries an extreme danger to humans.
Infectious-toxic shock
Infectious toxic shock is a sharp drop in blood pressure. It occurs against the backdrop of the negative effects of toxic substances that are produced by viruses or bacteria.
This species is often called septic shock, bacteriotoxic shock, or endotoxic shock. This is an extremely nonspecific clinical syndrome. It occurs mainly in a number of infectious diseases due to metabolic, neuroregulatory and hemodynamic disorders caused by bacteremia (viremia) and toxemia.
Often it occurs against the background of meningococcal infection, influenza, fever, abdominal and typhus, diphtheria, salmonellosis, dysentery and other dangerous infections. The mechanism of pathogenic disorders in this case is determined by the type of pathogen, the nature of the treatment, the intensity of the pathological processes in the body (organ), their degree and other parameters. Toxic shock is a serious disorder in the body.
Toxic shock syndrome
The toxic shock syndrome is a relatively rare disease. It is characterized by a sharp beginning. All this entails serious consequences for human life. This syndrome is able to quickly progress. Therefore, first aid measures should be carried out immediately.
There is a toxic shock syndrome on the background of infection with staphylococci and streptococci. Under normal conditions, they do not bother the person in any way. But for certain phenomena, they can release toxins that enter the bloodstream and lead to severe inflammatory reactions.
The reaction of the immune system leads to phenomena that are characteristic of the toxic shock syndrome. The streptococcal variety of "disease" is characteristic in the postpartum period, with complications after the acute respiratory disease, as well as in skin lesions.
Staphylococcal syndrome appears due to a forgotten tampon in the vagina. Therefore, you need to carefully monitor your own health. Because toxic shock is extremely negative for the body.
Toxic shock from tampons
Toxic shock from tampons can be caused by a staphylococcal infection. This is mainly due to a forgotten tampon in the vagina. The disease can quickly progress and lead to serious consequences. In some cases, eliminating negative symptoms is not so simple, and sometimes just impossible. A lethal outcome is observed in 8-16% of cases.
Often, this syndrome occurs in women aged 15-30 years. Naturally, this is due to the use of tampons during critical days. There were also cases when the syndrome appeared in women who prefer vaginal contraceptives.
The development of the disease is provoked by Staphylococcus aureus. These microorganisms are always in the mouth, nose, vagina and on the skin. Under adverse conditions, they cause serious damage to the body. A special danger is observed if the woman has a birth injury, irritation or scratches in the vagina.
It is necessary to understand that the toxic shock develops much more rapidly than the flu. Therefore, a sharp increase in body temperature and vomiting, should cause a woman's anxiety. Toxic shock requires emergency care.
Bacterial Toxic Shock
Bacterial toxic shock is also sometimes called septic shock. It can complicate the course of sepsis in any stage of its development. This phenomenon is a modified reaction of the body to the breakthrough into the blood of pyogenic microorganisms or their toxins.
It appears as a high temperature, sometimes it reaches 40-41 degrees. In this case, there is a tremendous chill, for which a strong sweating is characteristic. It is possible that the temperature drops to normal or subfebrile, due to severe sweating.
The mental state changes dramatically. A person feels anxiety, motor excitement, and in some cases, psychosis. These symptoms manifest themselves simultaneously with the fall of blood pressure, and oliguria or even preceding them. The pulse is frequent and reaches 120-10 beats per minute. The skin becomes pale, acrocyanosis is noted, and breathing is quickened. Urinary excretion is violated. Toxic shock requires immediate elimination.
Infectious Toxic Shock in Pneumonia
Infectious toxic shock in pneumonia is a special disease. It is characterized by the defeat of the alveoli (thin-walled vesicles that saturate the blood with oxygen). The cause of this phenomenon may be a number of pathogens. Basically it is: intracellular parasites, fungi, bacteria and viruses.
Different kinds of pneumonia have their own peculiarities. Often it can develop against the background of the transferred diseases, in the form of complications. Infectious toxic shock is a very serious complication. Most often it occurs against a background of bilateral inflammation of the lungs.
A toxic shock also develops in severe pneumonia, which is characterized by severe pulmonary tissue infiltration. The beginning complication can be determined by early signs. So, there is inhibition or anxiety. Usually these symptoms do not attract attention, which leads to a worsening of the situation. Over time, there is shortness of breath, tachycardia, and the pallor of the limbs is also possible. The skin becomes dry and warm. Toxic shock requires immediate elimination.
Infectious Toxic Shock in Children
Infectious toxic shock in children is a serious and dangerous condition. Caused it can be a complex infectious disease. The reason for this phenomenon lies in the ingress of microorganisms into the blood and the toxins released by them in the course of vital activity.
Toxins actively develop in the body and lead to spasms of small vessels and capillaries. Basically, in children this phenomenon occurs against the background of scarlet fever, diphtheria, dysentery and meningococcal infection. Everything is actively developing in the first day. At the same time there is a sharp increase in temperature, up to 41 degrees.
The condition of the child remains extremely difficult. He has a headache, vomiting, severe chills, convulsions and confusion. The pulse weakens, the heart begins to beat harder. Pallor of mucous membranes and skin is observed, strong sweating is not excluded.
Infectious toxic shock in a baby can develop against the background of infection through an abrasion or cut. Children should be warned against this and in time to treat the wounds with a special antiseptic. If you have negative symptoms, you should immediately consult a doctor. Self-medication in this case is inappropriate! If the toxic shock does not begin to be corrected correctly, then the lethal outcome is not ruled out.
Stages of infectious toxic shock
Stages of infectious toxic shock are of four types. So, the first "variation" was called - the phase of an early reversible shock. It is characterized by a shock index of up to 0.7-1.0, tachycardia, muscle pain, abdominal pain, headache and disorders from the central nervous system. There is a feeling of anxiety, anxiety and depression.
The second stage was called the phase of late reversible shock. At this stage, a critical drop in blood pressure (below 90 mm Hg) occurs, and the shock index reaches 1.0-1.4. The victim has a frequent pulse, inhibition and apathy. There is a violation of blood microcirculation. This can be determined visually by wet and cold skin, as well as its bluish color.
The third stage is the phase of stable reversible shock. The condition of the victim deteriorates sharply. The pressure gradually decreases, and the heart rate significantly increases. The shock index reaches 1.5. The bluish color of the skin and mucous membranes increases. There are signs of multiple organ failure.
The fourth stage is the most dangerous - the phase of irreversible shock. There comes a general hypothermia, the skin of a diseased earthy shade with bluish spots around the joints. Eliminate the toxic shock in this case is impossible.
Diagnosis of toxic shock
Diagnosis of toxic shock can be of several types. You can determine everything by the patient himself. So, the patient has a very "sad" and "heavy" appearance. The person is conscious, while he is pale, cyanotic, adynamic and inhibited.
The difference between the central and peripheral temperature of the body is up to 4 ° C. Diuresis is less than 0.5 ml / kg / hour. Gradually, the shock index of Algover is increasing. Determine the presence of a toxic shock in humans can be visually and with additional measurement of pressure and pulse.
At the first stage, the patient's condition is severe. He is agitated and is in motor trouble. The skin is pale, there is a tachycardia, a moderate shortness of breath and a decrease in diuresis. In the second stage, excitation is observed, which is replaced in due course by retardation. At the same time, the skin is pale, there is tachycardia, DIC syndrome, hypoxia, hypokalemia and hypotension. In the third stage, pronounced cyanosis, impaired consciousness, a drop in blood pressure, anuria and irreversible changes in the organs. Toxic shock is life-threatening and must be eliminated immediately.
What tests are needed?
Who to contact?
Treatment of toxic shock
Treatment of toxic shock includes a whole range of measures. The intensive care program of this disease consists in the complete restoration of the body. First of all, the main tasks are solved in the therapy of toxic shock. Then the fight with the focus of infection in the body begins.
Further, elimination of exogenous and endogenous intoxication is carried out. After a while hypovolemia is connected and stabilization of indicators of macrohemodynamics. Then, the mechanisms of autoaggression should be coped and the bioenergy deficit eliminated.
It is important to improve microcirculation in a timely manner. In general, the main goals of therapeutic measures are to restore microcirculation and arrest disseminated intravascular coagulation. This is done by simultaneously persistent infusion therapy and intravenous administration of pharmacological drugs.
As noted above, treatment takes place in several stages and depends on the condition of the person. So, if a shock occurs as a result of using tampons or contraceptives in a woman, it is worth immediately removing them from the body. Infected wounds are cleaned of bacteria by scraping with scalpels or scissors. For this, the doctor makes an injection so that the affected area is numb and the woman does not feel pain. Such an intervention is a surgical treatment of a wound. Once the focus of infection is removed, the patient will feel relieved.
Actively used for the destruction of bacteria, hormones and antibiotics. As hormonal drugs apply Prednisolone and Dexamethasone.
Prednisolone is used to eliminate allergic reactions and the effects of toxic shock. It is used only with the permission of the doctor. Apply it inwards, in the form of injections and topically. Inward - during or immediately after eating, 0,025-0,05 g per day (2-3 times), then the dose is reduced to 0.005 g 4-6 times a day (or 2-3 times a day for 0.01 g ). In the form of injections - intramuscularly (the contents of the ampoule are dissolved in 5 ml of water for injections, heated to 35-37 ° C, 0,03-0,06 g of the drug) and intravenously (jet or drip 0,015-0,03 g). Locally - 0.5% prednisolone ointment for skin diseases is used for anti-inflammatory and antiallergic action. The drug has some contraindications. It can not be used by people of advanced age and those who often have herpes. There are also possible side effects in the form of water retention in the body, manifestation of hyperglycemia, muscle weakness and amenorrhea.
Dexamethasone. The drug has anti-inflammatory, anti-allergic, anti-shock, immunosuppressive and antitoxic properties. Oral taken in the form of tablets in an amount of not more than 10-15 mg per day at the initial stage of treatment, followed by a decrease in the daily dose to 2-4.5 mg with maintenance therapy. The daily dose of the drug is divided into 3 divided doses. Supportive small doses should be taken once a day, preferably in the morning. In ampoules the agent is intended for intravenous injection intramuscularly, perarticularly and intraarticularly. The recommended daily dose of Dexamethasone for these methods of administration is 4-20 mg. In ampoules the medication is usually applied 3-4 times a day for 3-4 days with the subsequent transition to tablets. The drug is used only with the permission of the doctor. It can cause side effects, in the form of nausea, vomiting, pain in the stomach. In more complex cases, the appearance of intracranial pressure, the propensity to develop infectious eye diseases and weight gain are not ruled out. As for antibiotics, most often take Vancomycin, Daptomycin and Linezolid.
Vancomycin. The drug is administered exclusively intravenously at a rate of no more than 10 mg / min. The duration of the infusion should be at least 60 minutes. The daily dose for adults is 0.5 g or 7.5 mg / kg every 6 hours or 1 g or 15 mg / kg every 12 hours. If a person has impaired renal excretory function, the dosage regimen is corrected. In no case should you apply the drug during pregnancy, during breastfeeding and people who have hypersensitivity to certain components of the drug. It is not excluded the occurrence of side effects in the form of nausea, vomiting and allergic reaction. In more complex cases, reversible neutropenia, anaphylactoid reactions and hyperemia are formed.
Daptomycin. The drug is administered intravenously for at least 30 minutes. With complicated functions of the skin and soft tissues, 4 mg / kg is sufficient once a day for 1-2 weeks until the infection completely disappears. With bacteremia caused by Staph. Aureus, including established or suspected infective endocarditis, the recommended adult dose is 6 mg / kg 1 time / day for 2-6 weeks at the discretion of the attending physician. The drug may cause side effects. It manifests itself in the form of a fungal infection, mental disorders, nausea, vomiting and stomach pain. It is not excluded the appearance of hypersensitivity, swelling and chills.
Linezolid. Adults prescribe intravenous or oral 2 times a day for 400 mg or 600 mg once. The duration of treatment depends on the pathogen, localization and severity of the infection: in case of community-acquired pneumonia, 600 mg-10-14 days, hospital pneumonia 600 mg -10-14 days, infections of skin and soft tissues 400-600 mg, depending on the severity of the disease - 14-28 days, enterococcal infections - 14-28 days. Incorrect reception of the product can cause side effects. They appear in the form of nausea, vomiting, stomach pain, headache and reversible anemia.
It should be noted that each case in some way is individual. Therefore, to eliminate the toxic shock is necessary only after examining the doctor and revealing the stage of "disease".
Emergency care for infectious-toxic shock
Emergency care for infectious toxic shock should begin even before the person is hospitalized. Before the arrival of a doctor, you should try to warm the person and put a warmer on his feet. Then remove or unfasten the tight clothes. This ensures fresh air.
Immediately after hospitalization, a person is transferred to the intensive care unit. The corresponding therapy is performed here. Prior to the appointment of antibiotics, blood is sown. If there is a possibility, then all this is extracted from the foci of infection.
The complexity and severity of the septic process requires treatment aimed not only at fighting microorganisms, but also at eliminating metabolic disorders caused by intoxication and hypoxia. After the vital functions have been restored, the infection centers are sanitized. For emergency care use: intravenous drip injection of 200 mg of Dopamine, prednisolone at a dose of 10-15 mg / kg / day and inhalation with oxygen. Further treatment depends on the condition. In any case, the toxic shock should be eliminated immediately.
Prevention of toxic shock
Prevention of toxic shock is the observance of certain rules. So, women are advised not to use tampons and barrier contraceptives. The latest "inventions" are sponges, diaphragms and caps. Apply all this is not necessary for 3 months after childbirth. Because the vagina needs a little time to recover. Then tampons can be applied, but at the same time change them every 8 hours. Do not leave the contraceptive diaphragm or sponge for more than twelve hours.
The skin should always be kept clean. Abrasion and wounds must be treated immediately, so that they do not get an infection, can cause the development of toxic shock.
If a woman experiences menstrual syndrome of toxic shock, then she should stop using intrauterine spirals, tampons and barrier contraceptives. Toxic shock is a serious deviation, which can lead to disruption of the functions of the organs and systems of the body.
Forecast of toxic shock
The prognosis of toxic shock is relatively favorable. The success of recovery in people who have suffered this complication depends on the timeliness of diagnosis and treatment.
It is important that urgent care is provided quickly and professionally. Antibiotic therapy should be adequate, as well as successful. The main thing is that the sanation of the main bacterial focus was carried out correctly and efficiently.
Despite this, the mortality rate occupies high positions, but only in the first hours. If the infectious toxic shock was caused by streptococcus, the mortality rate reaches 65%. The causes of death are heart failure, multiple organ failure and arterial hypotension. With timely and adequate assistance, the patient completely recovers in 2-3 weeks. It is necessary to understand that it is much easier to warn than cure. Toxic shock is a serious deviation, which negatively affects many systems and organs of the human body.