Return to search

Síndrome de shock tóxico fulminante: reporte de un caso

Escolar de once años con cuadro inicial de monoartritis de
rodilla derecha por traumatismo local, fi ebre, trastorno del sensorio
y disnea. Es hospitalizado y recibe tratamiento antibiótico
empírico. El hemocultivo resulta positivo para Streptococcus
pyogenes, por lo que se decide corregir la cobertura antibiótica.
Sin embargo, el estado general del paciente empieza a
decaer e ingresa a la unidad de cuidados intensivos. A pesar
del tratamiento instaurado, el sujeto desarrolla shock séptico
y posteriormente falla multiorgánica, requiriendo soporte hemodinámico
y ventilatorio. Los síntomas se agravan y fallece
a las 38 horas de su admisión hospitalaria. / An 11-year-old scholar arrives in the emergency room with
right-knee monoarthritis due to local trauma, fever, sensory
loss, and dyspnea. He is hospitalized and receives empiric
antibiotic therapy. The blood culture set is positive for Streptococcus
pyogenes and the antibiotic spectrum is changed.
However, the patient’s general status deteriorates, and he is
admitted to the intensive care unit. Even with the treatment
received, he develops septic shock and multiorganic failure,
requiring hemodynamic and ventilatory support. Thirty-eight
hours after his admission, the patient dies.

Identiferoai:union.ndltd.org:PERUUPC/oai:repositorioacademico.upc.edu.pe:10757/611826
Date06 1900
CreatorsFigueroa Tarrillo, Jorge Arturo, Cerna Viacava, Renato, Linares Linares, Mariela Alejandra, Carreazo, Nilton Yhuri
Contributorsu201110520@upc.edu.pe
PublisherSociedad Mexicana de Pediatría
Source SetsUniversidad Peruana de Ciencias Aplicadas (UPC)
LanguageSpanish
Detected LanguageSpanish
Typeinfo:eu-repo/semantics/article
SourceUniversidad Peruana de Ciencias Aplicadas (UPC), Repositorio Académico - UPC
Rightshttp://creativecommons.org/licenses/by-nc-nd/4.0/, info:eu-repo/semantics/openAccess
Relation1. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. 1996; 334(4): 240-245. 2. Darenberg J, Luca-Harari B, Jasir A, Sandgren A, Pettersson H, Schalén C et al. Molecular and clinical characteristics of invasive group A streptococcal infection in Sweden. Clin Infect Dis. 2007; 45(4): 450-458. 3. Nogami Y, Tsuji K, Banno K, Umene K, Katakura S, Kisu I, Tominada E, Aoki D. Case of streptococcal toxic shock síndrome caused by rapidly progressive group A hemolytic streptococcal infection during postoperative chemotherapy for cervical cancer. J Obstet Gynaecol Res. 2014; 40(1): 250-254. 4. Lappin E, Ferguson AJ. Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009; 9(5): 281-290. 5. Carapetis JR, Steer AC, Mulholland EK et al. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005; 5(11): 685-694. 6. Lamagni TL. The epidemiology of severe Streptococcus pyogenes disease in Europe. University of Helsinki. J Clin Microbiol. 2008; 46(7): 2359-2367. 7. O’Grady KA, Kelpie L, Andrews RA et al. The epidemiology of invasive group A streptococcal disease in Victoria, Australia. Med J Aust. 2007; 186: 565-569. 8. Steer AC, Jenney AWJ, Kado J et al. Prospective surveillance of invasive group A streptococcal disease, Fiji, 2005-2007. Emerg Infect Dis. 2009; 15: 216-222. 9. Hoge CW, Schwartz B, Talkington DF et al. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome: a retrospective population-based study. JAMA. 1993; 269: 384-389. 10. Breiman R, Davis J, Facklam R, Gray B, Hoge C, Kaplan E et al. Defi ning the group A streptococcal toxic shock syndrome, rationale and consensus defi nition. JAMA. 1993; 269(3): 390-391. 11. Kotb M. Bacterial pyrogenic exotoxins as superantigens. Clin Microbiol Rev. 1995; 8: 411-426. 12. Low DE. Toxic shock syndrome: major advances in pathogenesis, but not treatment. Crit Care Clin. 2013; 29(3): 651-675. 13. Brown EJ. The molecular basis of streptococcal toxic shock syndrome. N Engl J Med. 2004; 350: 2093-2094. 14. Richter SS, Heilmann KP, Beekmann SE, Miller NJ, Miller AL, Rice CL et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis. 2005; 41(5): 599-608. 15. López AJM, Valerón LME, Consuegra LE, Urquía ML, Morón SCA, González JR. Síndrome de shock tóxico estreptocócico letal en pediatría: presentación de 3 casos. Med. Intensiva. 2007; 31(2): 100-103. 16. Rodríguez-Nuñez A, Dosil-Gallador S, Jordan I. Clinical characteristics of children with group A streptococcal toxic shock síndrome admitted to pediatric intensive care units. Eur J Pediatr. 2011; 170: 639-644. 17. Daskalaki MA, Boeckx W, DeMey A, Frank D. Toxic shock síndrome due to group A beta-hemolytic streptococcus presenting with purpura fulminans and limb ischemia in a pediatric patient treated with early microsurgical arteriolysis. J Pediatr Surg. 2013; 48: E1-E3. 18. Fox K, Born M, Cohen M. Fulminant infection and toxic shock syndrome caused by Streptococcus pyogenes. J Emerg Med. 2002; 22(4): 357-366.

Page generated in 0.0021 seconds