Popescu Cristina, Leuştean Anca, Orfanu Alina Elena, Carp Codruţa Georgiana, Aramă Victoria
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
"Prof. Dr. Matei Balş" National Institute for Infectious Diseases, Bucharest, Romania.
J Crit Care Med (Targu Mures). 2017 Nov 8;3(4):166-171. doi: 10.1515/jccm-2017-0030. eCollection 2017 Oct.
Streptococcal infection can be responsible for multiple complications, such as toxic, septic or allergic disorders. Toxin-mediated complications (TMC) can appear during the acute phase of disease and can involve any organ, causing carditis, arthritis, nephritis, hepatitis etc.
The case of a young woman without a history of recurrent streptococcal tonsillitis, admitted to "Matei Balş" National Institute for Infectious Diseases, Bucharest, Romania, presenting with fever, sore throat and exudative tonsillitis, is detailed. The initial test for Streptococcus pyogenes was negative. The patient had leukopenia with severe neutropenia, high values of inflammatory biomarkers and electrocardiographic (ECG) changes with inverted T waves in leads V1-4 and flattened T waves in V5-6. There were no other cardiac signs or symptoms. The patient received cefuroxime for two days. On admission, the patient was prescribed Penicillin G and dexamethasone which resulted in a rapid recovery. The leucocytes count returned to normal as did the ECG abnormalities. At the time of discharge, the antistreptolysin O titre was high.
The case highlights the toxin-mediated complications (TMC) of streptococcal infection which occur from the outset of the disease.
链球菌感染可引发多种并发症，如中毒、败血症或过敏性疾病。毒素介导的并发症（TMC）可在疾病急性期出现，可累及任何器官，导致心肌炎、关节炎、肾炎、肝炎等。
详细介绍了一名无复发性链球菌性扁桃体炎病史的年轻女性病例，该患者入住罗马尼亚布加勒斯特的“马泰·巴尔什”国家传染病研究所，表现为发热、咽痛和渗出性扁桃体炎。最初的化脓性链球菌检测为阴性。患者出现白细胞减少伴严重中性粒细胞减少、炎症生物标志物值升高以及心电图（ECG）改变，V1 - 4导联T波倒置，V5 - 6导联T波低平。无其他心脏体征或症状。患者接受了两天的头孢呋辛治疗。入院时，患者接受青霉素G和地塞米松治疗，病情迅速好转。白细胞计数恢复正常，心电图异常也消失。出院时，抗链球菌溶血素O滴度较高。
该病例突出了链球菌感染从疾病一开始就出现的毒素介导的并发症（TMC）。
