Zdziarski Przemysław
Poradnia Immunologiczna, Dolnoślaskie Centrum Transplantacji Komórkowych, Instytut Immunologii i Terapii Doświadczalnej Wrocław.
Pol Merkur Lekarski. 2005 Jun;18(108):693-5.
Toxic Shock Syndrome (TSS) is a potentially fatal illness caused by a particular strain of Staphylococcus aureus. The clinical presentation is similar to that of septic shock because of systemic inflammatory response syndrome-(SIRS). In the case report ineffective therapy of puerperal staphylococcal infection and its complication (reactive arthritis) with bacteriostatic and anti-inflammatory drug was described. 24 years old woman with puerperal infection was empirically treated with doxycycline. Fever and general weakness disappeared, but four weeks later gonarthritis with stiffening developed (reactive arthritis) treated with steroids plus amoxicillin-clavulanate. Unfortunately after regression of gonarthritis and steroid withdrawal TSS and SIRS suddenly occurred. It was successfully treated with penicillin plus gentamycin. In the history of TTS the infection and inflammation are closely interwoven: clinical recovery from immunocompromise is associated with the onset of SIRS. Further, bacterial growth occurs when inflammatory process was quite inhibited (by puerperium or steroids). The natural history of the TSS confirm that regression of inflammatory symptoms in infectious diseases (especially in SIRS) is not tantamount to recovery. Moreover, immunocompetence is main requirement of successful treatment with bacteriostatic agents.
中毒性休克综合征（TSS）是一种由特定金黄色葡萄球菌菌株引起的潜在致命疾病。由于全身炎症反应综合征（SIRS），其临床表现与感染性休克相似。在该病例报告中，描述了用抑菌和抗炎药物治疗产褥期葡萄球菌感染及其并发症（反应性关节炎）的无效治疗情况。一名患有产褥期感染的24岁女性经验性地接受了强力霉素治疗。发热和全身无力消失，但四周后出现了伴有僵硬的膝关节炎（反应性关节炎），用类固醇加阿莫西林 - 克拉维酸盐进行治疗。不幸的是，在膝关节炎消退且停用类固醇后，突然发生了TSS和SIRS。用青霉素加庆大霉素成功治愈。在TSS的病程中，感染和炎症紧密交织：免疫功能低下的临床恢复与SIRS的发作相关。此外，当炎症过程受到相当程度抑制（如产褥期或类固醇）时会发生细菌生长。TSS的自然病程证实，传染病中炎症症状的消退（尤其是在SIRS中）并不等同于康复。此外，免疫能力是使用抑菌剂成功治疗的主要条件。
