由Streptococcus pyogenes emm22引起的链球菌毒性冲击综合征 带有CsrS突变的基因型:一个案例报告
Kaoru Ogawa1, Jiro Kamiyama1, Tadayoshi Ikebe2
1Altitude Emergency and Critical Care Medical, Saitama Red Cross Hospital, Japan.
Japanese journal of infectious diseases
|February 28, 2024
概括
一个以前健康的年轻女子因感染Streptococcus pyogenes而心脏骤停. 尽管接受了重症监护,包括体外膜氧化,但她却因严重的 estreptococcal 毒性冲击综合征而死亡.
科学领域:
- 传染性疾病 传染性疾病
- 临界护理医学 临界护理医学
- 微生物学 微生物学
背景情况:
- 杆菌pyogenes可以引起严重的侵入性感染,包括杆菌毒性休克综合征 (STSS).
- 早期识别和管理对于患有不明原因的医院外心脏骤停 (OHCA) 的患者至关重要.
研究的目的:
- 报告一名患有OHCA的年轻女性致死性STSS病例.
- 详细说明严重S. pyogenes感染的临床过程,诊断结果和治疗挑战.
主要方法:
- 一个22岁的女性患有OHCA的案例报告.
- 临床管理包括血管压缩剂,过,抗生素,免疫球蛋白和体外膜氧化 (ECMO).
- 微生物学分析涉及血液培养,格拉姆染色,emm基因定型,以及病毒性基因 (speA, speB, speC) 和调控基因 (CsrS, CsrR, Rgg) 的测序.
主要成果:
- 患者呈现OHCA和不稳定的生命体征,初步调查未能确定原因.
- 血培养证实了Streptococcus pyogenes (emm22基因型) 具有链球菌热原毒素speA和speB的基因.
- 尽管进行了积极的治疗,包括因流体过载而导致呼吸衰竭的ECMO,但患者在入院40小时后死亡. 一个CsrS突变被确定.
结论:
- 这一案例凸显了STSS的快速进展和高死亡率,即使在以前健康的年轻人中也是如此.
- 积极的支持性护理和向性抗生素治疗是必不可少的,但在突发病例中可能不足.
- 需要进一步研究特定毒性因子和调控突变在STSS病原发生中的作用.
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