Wiles C E, Reynolds H N, Bar-Lavie Y
R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA.
Md Med J. 1998 Aug;47(4):188-90.
Group A streptococcus has emerged as a major cause of aggressive life-threatening deep-seated infections. In addition, toxic shock syndrome caused by Group A streptococcus was recognized in 1983. Group A streptococcus produces several potent exotoxins which explain the pathophysiology of these invasive infections. Other virulence factors such as M protein, which can impede phagocytosis, are associated with some Group A streptococcus. M protein and streptococcal pyrogenic exotoxins may act as super antigens. Host factors may influence the severity of infection. Blood purification techniques such as continuous renal replacement therapy and plasmapheresis can remove streptococcal exotoxins as well as inflammatory mediators. Replacement with fresh-frozen plasma corrects coagulopathy and may provide some antibody protection. Four patients with Group A streptococcus-toxic shock syndrome treated with continuous renal replacement therapy, plasmapheresis, or both showed dramatic, rapid improvement in cardiovascular dynamics and respiratory parameters. Two patients died. The mainstay of treatment for Group A streptococcus-toxic shock syndrome remains early diagnosis, aggressive surgical control of the infection, and appropriate antibiotics (i.e., penicillin and clindamycin). Flush resuscitation may rescue some patients from profound toxic shock. The mechanisms of action need to be delineated.
A组链球菌已成为侵袭性、危及生命的深部感染的主要病因。此外，1983年确认了由A组链球菌引起的中毒性休克综合征。A组链球菌产生多种强效外毒素，这些外毒素解释了这些侵袭性感染的病理生理学。其他毒力因子，如可阻碍吞噬作用的M蛋白，与部分A组链球菌有关。M蛋白和链球菌致热外毒素可能作为超抗原。宿主因素可能影响感染的严重程度。血液净化技术，如持续肾脏替代疗法和血浆置换，可以清除链球菌外毒素以及炎症介质。输注新鲜冷冻血浆可纠正凝血病，并可能提供一定的抗体保护。4例接受持续肾脏替代疗法、血浆置换或两者联合治疗的A组链球菌中毒性休克综合征患者的心血管动力学和呼吸参数显著、迅速改善。2例患者死亡。A组链球菌中毒性休克综合征的主要治疗方法仍然是早期诊断、积极的手术控制感染以及使用适当的抗生素（即青霉素和克林霉素）。液体复苏可能使一些患者从严重的中毒性休克中获救。其作用机制需要阐明。
