Many infectious diseases are caused by pathogenic bacteria that enter our bodies in various ways. In the process of their active life, a lot of harmful substances are released into the human body that can cause infectious toxic shock (ITS). This condition is dangerous in that its first symptoms are perceived by many as a cold. People are in no hurry to see a doctor, they are trying to be treated with completely useless medicines in this case, which further aggravate intoxication. In the meantime, severe pathological changes that can lead to death are continuing in the body. The All-Russian organization dealing with disaster medicine, together with the Profile Commission of the Ministry of Health of the Russian Federation, developed clinical recommendations for the treatment and diagnosis of toxic toxic shock. They are based on more than 20 years of experience and allow doctors to work clearly and quickly to save a person’s life. These recommendations are focused on the occurrence of ITS in emergency situations, but all of their provisions are relevant in everyday life.
General definition
Infectious toxic shock is an urgent pathological condition that requires medical attention as soon as possible. Bacteria of absolutely all types, having penetrated into any organ of the human body, begin to multiply rapidly. In an infected person, this process causes symptoms characteristic of each disease. At the same time, a person is poisoned with substances called exotoxins. Bacteria secrete them in the process of their life. If antibiotic treatment is not carried out, the patient's condition worsens significantly. Even death can occur.
However, you are mistaken if you think that antibiotics completely solve the problem. When bacteria are destroyed from their destroyed dead cells, individual structural components called endotoxins are released into the human body. By their nature, they are no less dangerous than exotoxins.
Both types of these substances harmful to humans, getting into the blood, cause a violation of its transport function, oxygen starvation of tissues and, as a result, severe pathologies of vital organs.
The ICD code of the 10th revision ICD shock is A48.3. This classification was adopted in 1989. It is the main statistical basis for healthcare in all countries of the world. The previous review was carried out in 1975. Although almost no one now uses the outdated classification, it can still be found in some textbooks. To make it clear what kind of disease we are talking about, we note that the ICD code of the 9th revision ICD is 040.82.
This condition can occur in people of any age, from infants to a very old man. Its occurrence is determined by the strength of the patient's immune system and the type of microbe.
In general terms, ITS can be characterized as a combination of a severe inflammatory process (underlying disease) and circulatory failure.
Pathogenesis
Microbiological studies have allowed a fairly detailed study of the pathogenesis of toxic toxic shock. Without therapy, bacterial toxins that destructively act on the cells enter the patient’s blood. These toxic substances are specific to each microbe, but all are very dangerous. For example, botulinum toxin in an amount of only 0, 0001 mg kills a guinea pig.
With intensive antibiotic therapy, a huge amount of cytokines, adrenaline and other substances penetrate the patient's blood, which cause cramping in arterioles and venules. As a result, blood cannot deliver oxygen and nutrients to organ tissues. This leads to their ischemia (oxygen starvation) and a violation of the acid-base balance of the body as a whole (acidosis).
The next step is the release of histamine, a decrease in the sensitivity of blood vessels to adrenaline, paresis of arterioles. Clinically, there is a leakage of blood from the vessels into the intercellular space.
This process is accompanied not only by bleeding, but also by a decrease in blood in the vessels of the body (hypovolemia). This is dangerous because fewer returns to her heart than is required for his normal work.
Ischemia and hypovolemia cause a malfunction of all systems. The patient is diagnosed with renal failure, breathing problems, heart rhythm disturbance and other dangerous symptoms.
Etiology
Infectious toxic shock in most cases occurs with diseases accompanied by bacteremia (microbes circulate in the blood), such as leptospirosis, typhoid fever. However, it often becomes a complication of such ailments:
- Pneumonia.
- Salmonellosis.
- Dysentery.
- HIV or AIDS.
- Scarlet fever.
- Diphtheria.
Some viral diseases can also cause ITS:
Also at risk are patients who are diagnosed with:
- Tracheitis.
- Sinusitis.
- Postpartum sepsis.
- Complicated abortion.
- Postoperative infections.
- Closed wounds (in the nose).
- Allergic dermatitis.
- Open wounds, including burns.
In women, ITS may result from the use of hygienic tampons, which sometimes help penetrate the vagina of Staphylococcus aureus.
In medical practice, cases of the onset of toxic toxic shock when using insufficiently sterile vaginal contraceptives have been recorded.
Representatives of both sexes who use drugs may also have ITS.
Pre-shock state
There are three degrees of infectious toxic shock, called compensated, decompensated and irreversible. However, many doctors distinguish a fourth degree, called pre-shock or early.
This condition may have the following symptoms:
- Blood pressure is stable, and pulse pressure is lowered.
- Tachycardia.
- Headache.
- Mild nausea.
- Weakness.
- Muscle pains.
- Unreasonable depression, a sense of anxiety.
- The skin is warm, only legs or hands can be cold.
- The color of the skin is normal.
- In some people, the temperature rises to around 39-40 degrees.
- Hemorrhages in the mucous membrane of the eye.
The shock index is less than 1.0.
When such symptoms appear against the background of the course of an infectious disease, it is necessary to call an ambulance, since it is impossible to treat the toxic toxic shock at home. The emergency care that the patient's relatives should provide is the following actions:
- Provide fresh air to the room.
- Remove (or unfasten) tight clothing from the patient.
- Put a heating pad under his feet and a pillow under his head.
It is important to note that even with symptoms of a pre-shock state, hospitalization is required.
First degree
It is called pronounced or compensated shock. At this stage, the patient has:
- Lowering blood pressure to critical levels.
- Weak and frequent pulse (over 100 beats per minute).
- The skin is cold and wet.
- Cyanosis.
- Inhibition of reactions.
- Apathy.
- Tachypnea. For adults, it is 20 breaths per minute. For children - 25, for infants - 40.
The shock index is in the range 1.0-1.4.
Medical care for infectious toxic shock of the second degree should be provided immediately. It includes measures to detoxify the body, resume normal blood circulation, ensure stable breathing and a heartbeat.
Second degree
Its name is decompensated shock. The patient's condition continues to worsen. He has observed:
- Blood pressure at 70 mm. Hg. Art. and below.
- High heart rate.
- General cyanosis.
- Dyspnea.
- Sometimes jaundice or marbling can be observed.
- Oliguria.
- In some patients, a rash with necrosis may occur.
The shock index has a value of 1.5. At this stage, severe, sometimes irreversible, disorders in the organs occur. Especially dangerous are such pathologies in the central nervous system. However, with timely and competent medical care, the patient can still be saved.
Third degree
This condition develops in patients who were not helped on time. It is called a late stage or an irreversible shock. Moreover, irreversible transformations occur in internal organs, often incompatible with life. Infectious toxic shock clinic at this stage:
Hypothermia (body temperature below 35 degrees).
- The skin is cold, earthy in color.
- Cyanosis around the joints.
- Involuntary bowel movements.
- Anuria
- Very difficult breathing.
- Masked face.
- The pulse is threadlike (sometimes it is not heard at all).
- Loss of consciousness.
- Coma.
- The shock index is above 1.5.
Note that in most cases ITSh is developing very quickly. In some patients, the first two stages are so transient that they cannot be differentiated. Therefore, there is no need to tempt fate, doubt and hope for a miracle. In the event of the pre-shock signs described above, it is necessary to immediately call an ambulance. Remember, the third (last) stage can occur within 1 hour.
Infectious toxic shock in children
In children, as in adults, ITSH occurs as a result of poisoning of the body with endo- and exotoxins secreted by pathogenic microbes. Its features in the rapid (sometimes lightning-fast) development of a decrease in blood circulation in the vessels, which leads to the death of cells of all organs. The most dangerous for children (especially infants) are staphylococci and streptococci. As a rule, babies do not yet have strong immunity, so bacterial diseases in them are more difficult.
Very often, children develop an infectious toxic shock with pneumonia. The lungs of small patients are very vulnerable to toxic toxins. With the cessation of blood circulation in microvessels and paresis of capillaries, microembolism is observed in the alveoli, which leads to hypoxia. A child may die not from the underlying disease (in this case, pneumonia), but from asphyxiation.
Other dangerous diseases and conditions that can lead to ITS:
- Hives.
- Allergy.
- Dysbacteriosis
- Dysentery.
- Chickenpox.
- HIV AIDS.
- Scarlet fever.
- Diphtheria.
Parents should pay attention to the following symptoms in the child:
- A sharp increase in temperature.
- Fever.
- Small rash on the palms and feet.
- Lethargy (baby, like a rag), caused by a sharp decrease in blood pressure.
- Marbling or other discoloration of the skin.
- Decreased urine output (can be seen by the diaper change rate).
- Vomiting, diarrhea (watery stools).
- Conjunctivitis (does not appear in all cases).
Each parent should clearly understand that it is unacceptable to self-medicate. At the slightest suspicion of an infectious toxic shock, there is only one recommendation - to immediately call an ambulance. Before her arrival, the baby should be given room temperature water to drink. If he has chills and icy limbs, you need to warm the child, and at high temperature, on the contrary, remove excess (especially woolen) clothes from him. It is also required to open a window in the room, providing an influx of fresh air.
If ITSH has arisen during treatment with antibiotics, it is necessary to stop taking them before the doctors arrive. It is also unacceptable to give a child an antipyretic and a cure for diarrhea. At a very high temperature, you can undress the baby and wipe it with water at room temperature, put a cold compress on your forehead, which must be changed regularly.
Urgent Care
Due to the very rapid development of an infectious-toxic shock, ambulance doctors often begin to provide emergency care right on the spot.
The first action is stabilization of respiration. If necessary (the patient does not breathe), artificial lung ventilation and oxygen therapy are performed.
Next, ambulance doctors administer intravenously vasopressors - Norepinephrine or Norepinephrine with saline. The dosage may vary, depending on the age of the patient and on his condition. Glucocorticosteroids are also administered intravenously. Most commonly used are Prednisone or Dexamethasone. Children can be given “Metipred Bolus” in the calculation - 10 mg / kg for the second degree, 20 mg / kg for the third, 30 mg / kg for the fourth.
In the intensive care unit continue to provide emergency care. Patients are injected with catheters into the bladder and subclavian vein. Constantly monitor breathing and heart function, monitor the amount of urine excreted. Patients are given:
- Inotropic drugs (regulate heart contractions).
- Glucocorticosteroids.
- Colloidal solutions (correct hemorheological disorders).
- Antithrombin.
Diagnostics
Research is carried out while the patient is in the intensive care unit. Perform the following analyzes:
- Blood biochemical (with its help determine the type of pathogen, its reaction to antibiotics).
- Total urine and blood.
- The amount of urine excreted per day is measured.
- If necessary, instrumental diagnostics are carried out, including ultrasound, MRI, ECG. It is needed to determine the degree of pathological changes in vital organs.
Infectious toxic shock is diagnosed on the basis of clinical signs (until test results are obtained). Its main criteria:
- Dynamic progression of deterioration over a short period of time.
- Cyanosis.
- Acute respiratory failure.
- The appearance of cadaveric spots on the neck, trunk, legs.
- Very low blood pressure (down to zero).
Infectious Toxic Shock Treatment
In the intensive care unit, the patient continues to undergo mechanical ventilation and oxygen therapy (using a mask or nasal catheter). Pressure is measured every 10 minutes, and when the condition stabilizes - every hour.
Also regularly check the amount of urine output. If the indicators reach values of 0.5 ml / min. - 1.0 ml / min, this indicates the effectiveness of resuscitation.
It is mandatory to carry out infusion therapy. It involves the introduction of an intravenous crystalloid solution (1.5 liters), “Albumin” or “Reopoliglyukin” (1.5-2.0 L). Doses are given for adults. For children, they are calculated per kg of weight.
To restore blood flow in the kidneys, Dolamine is administered. Dosage: 50 mg of the drug in 250 ml of glucose 5%.
To restore blood flow in the vessels, glucocorticosteroids are administered. For those with first-degree ITS, Prednisolonum is administered intravenously every 6-8 hours, and for patients with the third and second degree of shock every 3-4 hours.
If hypercoagulation of DIC syndrome is observed, “Heparin” is administered. First, this is done in a jet, and then drip. At the same time, blood coagulation indicators must be constantly monitored.
Also, the patient is given antibacterial therapy and detoxification of the body.
After removing the patient from ITS, intensive treatment is continued to exclude any failure (cardiac, pulmonary, renal).
Forecasts
Unfortunately, only with the first degree of toxic shock is the prognosis favorable. If the patient was delivered to the intensive care unit on time and the necessary therapy was carried out, he is usually discharged from the hospital in satisfactory condition after 2-3 weeks.
In the second degree of ITS, the forecast depends on three factors:
- Professionalism of doctors.
- How strong is the patient’s body.
- What microbe caused ITSH.
In the second degree, approximately 40-65% of deaths are observed.
In the third degree, ITSH survives a very small percentage of patients. After the transfer of such a serious condition, people need a long rehabilitation in order to restore the work of the organs in which the changes took place.