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Der Anaesthesist

, Volume 52, Issue 9, pp 805–813 | Cite as

Intensivmedizinische Besonderheiten beim toxischen Schocksyndrom ("toxic-shock-syndrome", TSS)

Übersichtspublikation und Fallbericht zu einem TSST-1-assoziierten Toxic-Shock-Syndrome mit ARDS und Multiorganversagen nach staphylogenem Panaritium
  • C. Lang
  • H. Behnke
  • J. Bittersohl
  • L. Eberhart
  • E. Walthers
  • F. Sommer
  • H. Wulf
  • G. Geldner
Intensivmedizin

Zusammenfassung

Das toxische Schocksyndrom ("toxic-shock-syndrome", TSS) ist eine potentiell tödlich verlaufende Erkrankung mit einer Inzidenz von 0,5 pro 100.000 Einwohner und einer Letalität von 2–11%. Auslöser sind zumeist staphylogene Toxine wie das Toxic-Shock-Syndrome-Toxin-1 (TSST-1) sowie andere Endo- und Enterotoxine. Das TSS ist gekennzeichnet durch die Leitsymptome Fieber, Hypotension und Exanthem. Man unterscheidet das menstruelle TSS in Assoziation mit Tamponbenutzung vom nichtmenstruellen Toxic-Shock-Syndrome im Zusammenhang mit staphylokokkenbedingten Erkrankungen insbesondere der Haut und des Respirationstraktes. Die Superantigenwirkung der bakteriellen Toxine aktiviert das lymphozytäre Immunsystem, das Gerinnungs- und Komplementsystem sowie eine Reihe weiterer Mediatorenkaskaden. Dadurch sind fulminante Krankheitsverläufe mit Störungen multipler Organsysteme ("multiple organe dysfunction syndrome", MODS) bis hin zum Multiorganversagen ("multiple organe failure", MOF) mit letalem Ausgang möglich.

Schlüsselwörter

Toxisches Schocksyndrom (TSS) Akutes Lungenversagen (ADRS) Multiorganversagen (MOF) Extrakorporale Lungenaugmentation (ECLA) 

Abstract

Toxic-shock-syndrome (TSS) is an acute febrile, exanthematous illness caused by toxins such as toxic-shock-syndrome-toxine-1 (TSST-1) and other endotoxines from staphylococcus aureus with an incidence of 0,5 per 100.000 inhabitants. Patients with menstrual toxic-shock-syndrome (menstrual-TSS) usually have TSS associated with menstruation and use of a vaginal device such as tampons. Other patients with non-menstrual toxic-shock-syndrome (non-menstrual-TSS) have a focus of staphylococcal infection such as a surgical wound infection or soft tissue abscess. TSS usually presents with fever, pharyngitis, diarrhoea, vomiting, myalgia and may progress rapidly (within hours) to signs of hypovolaemic hypotension and shock. In some cases TSS is associated with multisystem failure including shock, renal failure, myocardial failure and adult respiratory distress syndrome. In its acute phase the diagnosis of TSS is often uncertain because of its initial symptoms are non-specific and numerous conditions need to be considered in the differential diagnosis. But obviously less incidence, the signs and symptoms of toxic-shock-syndrome should be recognised early to permit successful therapy. The site of infection should be adequately drained and treated with antimicrobial therapy. Possible complications including ARDS and myocardial failure require a thorough understanding of its underlying pathophysiology to ensure appropriate intensive-care treatment. Only if appropriate therapy is instituted as early as possible, most of patients will be able to survive their toxic-shock-syndrome. In other cases TSS can be a rapidly progressive and perhaps lethal ending disease because of possible multiple organe failure such as ARDS.

Keywords

Toxic-shock-syndrome (TSS) Adult respiratory distress syndrome (ARDS) Multiple organe failure (MOF) Extracorporal lung assist (ECLA) 

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • C. Lang
    • 1
    • 2
  • H. Behnke
    • 1
  • J. Bittersohl
    • 1
  • L. Eberhart
    • 1
  • E. Walthers
    • 1
  • F. Sommer
    • 1
  • H. Wulf
    • 1
  • G. Geldner
    • 1
  1. 1.Klinik für Anästhesie und IntensivtherapieInterdisziplinäres Medizinisches Zentrum, Klinikum der Philipps-UniversitätMarburg
  2. 2.Klinik für Anästhesie und IntensivtherapieInterdisziplinäres Medizinisches Zentrum, Klinikum der Philipps-Universität, MarburgMarburg

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