Skip to main content
SpringerLink
Log in

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

  • Intensivmedizin
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

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.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1.
Abb. 2.
Abb. 3.
Abb. 4.
Abb. 5.

Literatur

  1. Altemeier WA, Lewis SA, Schlievert PM, Bergdoll MS, Bjornson HS, Staneck JL, Crass BA (1982) Staphylococcus aureus associated with toxic shock syndrome: phage typing and toxin capability testing. Ann Intern Med 96: 978–982

    CAS  PubMed  Google Scholar 

  2. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 12: 319–323

    Google Scholar 

  3. Bergdoll MS, Crass BA, Reiser RF, Robbins RN, Davis JP (1981) A new staphylokokkal enterotoxin, enterotoxin F, associated with toxic-shock-syndrome Staphylokokkus aureus isolates. Lancet I: 1017–1021

    Google Scholar 

  4. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: 818–824

    CAS  PubMed  Google Scholar 

  5. Bertram H, Wilken M (1993) Menstruelles toxisches Schocksyndrom. Klin Padiatr 205: 373–378

    CAS  PubMed  Google Scholar 

  6. Broome CV (1989) Epidemiology of toxic shock syndrome in the United States: overview. Rev Infect Dis. 11 Suppl 1: 14–21

    Google Scholar 

  7. Chesney PJ, Davis JP, Purdy WK, Wand PJ, Chesney RW (1981) Clinical manifestations of toxic shock syndrome. JAMA 246: 741–748

    Google Scholar 

  8. Chesney PJ, Crass BA, Polyak MB, Wand PJ, Warner TF, Vergeront JM, Davis JP, Tofte RW, Chesney RW, Bergdoll MS (1982) Toxic shock syndrome: management and long-term sequelae. Ann Intern Med 96: 847–851

    CAS  PubMed  Google Scholar 

  9. Chesney PJ (1989) Clinical aspects and spectrum of illness of toxic shock syndrome: overwiew. Rev Infect Dis (Suppl 1) 11: 1–7

    PubMed  Google Scholar 

  10. Crass BA, Bergdoll MS (1986) Toxin involvement in toxic shock syndrome. J Infect Dis 153:918–926

    CAS  PubMed  Google Scholar 

  11. Davis JP, Chesney PJ, Wand PJ, LaVenture M (1980) Toxic-shock-syndrome: epidemiologic features, recurrence, risk factors, and prevention. N Engl J Med 303: 1429–1435

    Google Scholar 

  12. Dickgießer N, Kustermann B (1987) IgG-Antikörper gegen das Toxic-shock-Syndrom-Toxin-1 (TSST-1) in Humanseren. Klin Wochenschr 65: 256–258

    PubMed  Google Scholar 

  13. Dickgießer N, Wallach U (1987) Toxic shock syndrome toxin-1 (TSST-1): Influence of its production by subinhibitory antibiotic concentrations. Infection 15: 351–353

    PubMed  Google Scholar 

  14. Fleischer B (1991) Superantigene: Schock und Immunuppression als Folge der T-Zell-Stimulation. Gelben Hefte 4: 141–147

    Google Scholar 

  15. Gattinoni L, Agostoni A, Pesenti A, Pelizzola A, Rossi GP, Langer M, Vesconi S, Uziel L, Fox U, Longoni F, Kolobow T, Damia G (1980) Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporal removal of CO2. Lancet 2: 292–294

    CAS  PubMed  Google Scholar 

  16. Gaventa S, Reingold AL, Hightower AW, Broome CV, Schwartz B, Hoppe C, Harwell J, Lefkowitz LK, Makintubee S, Cundiff DR, Sitze S (1989) Active surveillance for toxic shock syndrome in the United States, 1986. Rev Infect Dis (Suppl 1) 11: 28–34

  17. Heeg K (1996) Superantigene—Bedeutung als Sepsisinduktoren. Infusionsther Transfusionsmed 23: 15–21

    CAS  PubMed  Google Scholar 

  18. Hirschberg R, Schaefer K (1983) Syndrom des toxischen Schocks. Pathogenese, Diagnose, Therapie. Dtsch Med Wochenschr 108: 912–917

    CAS  PubMed  Google Scholar 

  19. Hörmann C, Benzer H, Putensen C, Koller W, Putz G, Lingnau W (1992) ARDS des Erwachsenen. Anaesthesist Intensivmed Notfallmed Schmerzther 27:305–309

    Google Scholar 

  20. Kain KC, Schulzer M, Chow AW (1993) Clinical spectrum of nonmenstrual toxic shock syndrome (TSS): comparison with menstrual TSS by multivariate discriminant analyses. Clin Infect Dis 16: 100–106

    CAS  PubMed  Google Scholar 

  21. Knoch M, Müller E, Höltermann W, Konder H, Lennartz H ( 1987) Erfahrungen mit der extrakorporalen CO2-Elimination. Anästhesist 36: 210–216

    CAS  PubMed  Google Scholar 

  22. Kolobow T, Gattinoni L, Tomlinson T, Pierce JE (1978) An alternative to breathing. J Thorac Cardiovasc Surg 75: 261–266

    CAS  PubMed  Google Scholar 

  23. Larkin MS, Williams DN, Osterholm MT, Tofte RW, Posalaky Z (1982) Toxic shock syndrome: clinical, laboratory, and pathologic findings in nine fatal cases. Ann Intern Med 96: 858–864

    CAS  PubMed  Google Scholar 

  24. Miyashita T, Shimamoto Y, Nishiya H, Koshibu Y, Sugiyama H, Ono Y, Satoh T, Haraoka H, Nakano J, Ohta K, Sato T, Morinaga N, Noda M (2002) Destructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremia. J Infect Chemother 8: 99–102

    PubMed  Google Scholar 

  25. Miva K, Fukuyama M, Kunitomo T, Igarashi H (1994) Rapid assay for detection of toxic shock syndrome toxin 1 from human sera. J Clin Microbiol 32: 539–542

    PubMed  Google Scholar 

  26. Müller E, Kolobow T, Knoch M, Höltermann W (1992) Akutes Lungenversagen—Unterstützung des Gasaustausches mittels extrakorporaler oder implantierter Oxygenatoren—Gegenwärtiger Stand und zukünftige Entwicklung. Anaesthesist Intensivmed Notfallmed Schmerzther 27: 259–273

    PubMed  Google Scholar 

  27. Paris AL, Herwaldt LA, Blum D, Schmid GB, Shands KN, Broome CV ( 1982) Pathologic findings in twelve fatal cases of toxic shock syndrome. Ann Intern Med 96: 852–857

    CAS  PubMed  Google Scholar 

  28. Parsonnet J (1989) Mediators in the pathogenesis of toxic shock syndrome. Rev Infect Dis (Suppl 1) 11: 263–269

    Google Scholar 

  29. Peters G (1986) Toxic-Shock-Syndrom. Münch Med Wochenschr 128: 345–346

    Google Scholar 

  30. Raumanns J, Kaufhold A, Behrendt W, Peters G (1995) Letal verlaufendes nicht-menstruelles Toxic-Shock-Syndrom bei Staphylokokkus aureus-Sepsis. Anaesthesist 44: 869–874

    Article  CAS  PubMed  Google Scholar 

  31. Reingold AL, Hargrett NT, Dan BB, Shands KN, Strickland BY, Broome CV (1982) Nonmenstrual toxic shock syndrome: a review of 130 cases. Ann Intern Med 96: 871–874

    CAS  PubMed  Google Scholar 

  32. Reingold AL (1991) Toxic shock syndrome: an update. Am J Obstet Gynecol 165: 1236–1239

    CAS  PubMed  Google Scholar 

  33. Rossaint R, Slama K, Falke KJ (1991) Therapie des akuten Lungenversagens. Dtsch Med Wschr 116: 1635–1639

    CAS  PubMed  Google Scholar 

  34. Rossaint R, Lewandowski K, Pappert D, Slama K, Falke K (1994) Die Therapie des ARDS. Teil 1: Aktuelle Behandlungsstrategien einschließlich des extrakorporalen Gasaustauschs. Anaesthesist 43: 298–308

    Article  CAS  PubMed  Google Scholar 

  35. Rossaint R, Pappert D, Gerlach H, Falke K (1994) Die Therapie des ARDS. Teil 2: Neue Behandlungsmethoden—erste klinische Erfahrungen. Anästhesist 43:364–375

    Article  CAS  PubMed  Google Scholar 

  36. Schlievert PM, Shands KN, Dan BB, Schmid GP, Nishimura RD (1981) Identification and characterization of an exotoxin from Staphylococcus aureus associated with toxic-shock syndrome. J Infect Dis 143: 509–516

    Google Scholar 

  37. Schlievert PM (1989) TSST-1: structure, function, purification and detection. Role of toxic shock syndrome toxin 1 in toxic shock syndrome: overwiew. Rev Infect Dis (Suppl 1) 11: 107–109

    Google Scholar 

  38. Schröder E, Kunstmann G, Hasbach H, Pulverer G (1988) Prevalence of serum antibodies to toxic-shock-syndrome-toxin-1 and to staphylokokkal enterotoxins A, B and C in West-Germany. Zbl Bakteriol Ser A 270: 110–114

    Google Scholar 

  39. Seeger W, Walmrath D, Grimminger F (1995) ARDS. Intensivtherapie des akuten Lungenversagens. Internist 36: 785–801

    CAS  PubMed  Google Scholar 

  40. Stevens D, Bryant AE, Hackett SP (1993) Sepsis syndromes and toxic shock syndromes: Concepts in pathogenesis and a perspective of future treatment strategies. Curr Opin Infect Dis 6: 374–383

    Google Scholar 

  41. Stolz SJ, Davis JP, Vergeront JM, Crass BA, Chesney PJ, Wand PJ, Bergdoll MS (1985) Development of serum antibody to toxic shock toxin among individuals with toxic shock syndrome in Wisconsin. J Infect Dis 151: 883–889

    CAS  PubMed  Google Scholar 

  42. Thiel M, Forst H, Peter K ( 1991) Pathophysiologische und therapeutische Aspekte beim akuten Lungenversagen (ARDS). Anaesthesist Intensivmed Notfallmed Schmerzther 26: 3–11

    CAS  PubMed  Google Scholar 

  43. Todd JK, Fishaut M, Kapral F, Welch T (1978) Toxic-shock-syndrome associated with phage-group-I staphylokokki. Lancet II: 1116–1118

    CAS  PubMed  Google Scholar 

  44. Todd JK, Todd BH, Franco-Buff A, Smith CM, Lawellin DW (1987) Influence of focal growth conditions on pathogenesis of toxic shock syndrome. J Infect Dis 155: 673–681

    CAS  PubMed  Google Scholar 

  45. Todd JK (1990) Therapy of toxic shock syndrome. Drugs 39: 856–861

    CAS  PubMed  Google Scholar 

  46. Tofte RW, Williams DN (1982) Clinical and laboratory manifestations of toxic shock syndrome. Ann Intern Med 96: 843–847

    CAS  PubMed  Google Scholar 

  47. Uchiyama T, Yan XJ, Imanishi K, Yagi J (1994) Bacterial superantigens-mechanism of T-cell activation by the superantigens and their role in the pathogenesis of infectious diseases. Microbiol Immunol 38: 245–256

    CAS  PubMed  Google Scholar 

  48. Vergeront JM, Stolz SJ, Crass BA, Nelson DB, Davis JP, Bergdoll MS (1983) Prevalence of serum antibody to staphylococcal enterotoxin F among Wisconsin residents: implications for toxic-shock syndrome. J Infect Dis 4: 692–698

    Google Scholar 

  49. Vischer WA, Stadler H, Faupel DM (1985) Frequenz von "Toxic-Shock-Syndrom-Toxin"- bildenden Stämmen von Staphylokokkus aureus in der Region Basel. Schweiz Med Wschr 115: 1196–1199

    CAS  PubMed  Google Scholar 

  50. Voss A, Wallrauch-Schwarz C, Milatovic D, Braveny I, Johannigmann J, Hanke-Baier P (1993) Quantitative Untersuchung der Vaginalflora im Verlauf des Menstruationszyklus. Geburtshilfe Frauenheilk 53: 543–546

    CAS  PubMed  Google Scholar 

  51. Weitz G, Djonlagic H, Montzka P, Steinhoff J, Dodt C (2000) Toxisches Schocksyndrom mit Multiorganbeteiligung. Dtsch Med Wschr 125: 1530–1534

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesie und Intensivtherapie, Interdisziplinäres Medizinisches Zentrum, Klinikum der Philipps-Universität, Marburg

    C. Lang, H. Behnke, J. Bittersohl, L. Eberhart, E. Walthers, F. Sommer, H. Wulf & G. Geldner

  2. Klinik für Anästhesie und Intensivtherapie, Interdisziplinäres Medizinisches Zentrum, Klinikum der Philipps-Universität, Marburg, Baldinger Straße, 35033 , Marburg

    C. Lang

Authors
  1. C. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Behnke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Bittersohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Eberhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Walthers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Wulf
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Geldner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Lang.

Hinweis

Hinweis

Kontaktadresse für Fälle von Toxic-Shock-Syndrome: Französisches Referenzzentrum "Centre national de reference de toxemies à staphylocoques" (dm3.univ-lyon1.fr/staph/accueil_staph.htm)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lang, C., Behnke, H., Bittersohl, J. et al. Intensivmedizinische Besonderheiten beim toxischen Schocksyndrom ("toxic-shock-syndrome", TSS). Anaesthesist 52, 805–813 (2003). https://doi.org/10.1007/s00101-003-0552-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-003-0552-5

Schlüsselwörter

Keywords

Search

Navigation