Open AccessDiagnosis and treatment of streptococcal toxic shock syndrome in the pediatric intensive care unit: case report
Author(s) -
Haroldo Teófilo de Carvalho,
José Roberto Fioretto,
Cristiane Franco Ribeiro,
Isabela Ortiz Laraia,
Mário Ferreira Carpi
Publication year - 2019
Publication title -
revista brasileira de terapia intensiva
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.431
H-Index - 19
eISSN - 1982-4335
pISSN - 0103-507X
DOI - 10.5935/0103-507x.20190068
Subject(s) - medicine , fasciitis , septic shock , intensive care medicine , etiology , shock (circulatory) , differential diagnosis , pediatrics , dermatology , surgery , sepsis , pathology
Among the infections caused by Streptococcus β hemolyticus from the Lancefield serogroup A, toxic shock syndrome is perhaps the most severe, and its mortality rate is high. Its clinical similarity to other forms of shock, especially septic shock, can often confuse the evaluator and interfere with the selection of the most appropriate therapy. This report aims to inform readers of the need to add this syndrome as a differential diagnosis in cases of shock, especially those with no well-defined clinical manifestations. For this purpose, we present the case of an infant with common flu-like symptoms who progressed rapidly with a rash, a reduced level of consciousness and clinical and laboratory signs of shock that required intensive support. In addition to cultures indicating the etiological agent, the appearance of exanthema and necrotizing fasciitis led to the diagnosis. However, less than 50% of cases present classic clinical signs of this entity. Penicillins combined with aminoglycosides are still the therapy of choice and are supported by a high level of evidence. Despite the severity of this patient's presentation, the progression was satisfactory.