Kemohelo ea Toxic Shock Syndrome (TSS) le Tlhokomelo ea Tšohanyetso¶

Toxic shock syndrome (TSS) ke boemo ba tšohanyetso ba bongaka bo sa tloaelehang, bo tletseng, bo nang le chefo bo bakoang ke baktheria e matla superantigens e hlahisoang maling ke mefuta e itseng ea Staphylococcus aureus kapa Sehlopha A Streptococcus (Streptococcus pyogenes) Ho fapana le ts'oaetso e tloaelehileng ea baktheria moo libaktheria li tlamehang ho ata ho pholletsa le mali ho baka tšabo, ka staphylococcal toxic shock syndrome, kolone ea baktheria e sebakeng seo hangata e se nang bohloko ka ho feletseng e lutseng ka har'a tampon ea botšehali, senoelo sa ho ilela khoeli, seponche sa lithibela-pelehi, ho paka ka nko ka mor'a ho tsoa mali kapa ho buuoa ka sinus, postpartum uterus, kapa leqeba le lenyenyane le lenyenyane Toxic Shock Syndrome Toxin-1, kapa TSST-1) e tšelang ka kotloloho maling, e khutsufatsang sesole sa 'mele oa motho, 'me e baka koluoa ​​* ea sefefo sa cytokine, leak ea capillary, khatello ea mali e tlase, le ho hloleha ha litho tse ngata nakong ea lihora tse 12 ho isa ho tse 48**.

Boikarabello ba hau hanghang ha ho belaelloa hore ho na le toxic shock syndrome ke ho hlokomela lets'oao la** feberu e matla ea tšohanyetso e ka holimo ho likhato tse 38.9 tsa Celsius (102.0 degrees Fahrenheit), ho ntša lekhopho le lefubelu la letlalo le "chesang ke letsatsi" (erythroderma), ho hlatsa kapa letšollo le nang le metsi, ho opa ho matla ha mesifa, mahlo a tšolohang, le ho tsieleha ha setho sa botona kapa ho akheha* tampon, senoelo sa ho ilela khoeli, sekoaelo sa lithibela-pelehi, kapa sephutheloana sa maqeba a sa buuoeng ** ho emisa tlhahiso ea chefo e tsoelang pele, letsetsa litšebeletso tsa bongaka tsa tšohanyetso hang-hang, ho robatsa mokuli ka maoto a tšehelitsoeng haeba a ikutloa a le molichaba kapa a akhehile, 'me a li tsamaise ka potlako bakeng sa ho khutlisa mokelikeli oa sepetlele ka methapo, lithibela-mafu tse kenang methapong, le tlhahlobo ea maqeba a ho buuoa.

Etsa sena hona joale¶

1. Letsa lits'ebeletso tsa bongaka tsa tšohanyetso hang-hang: Letsetsa nomoro ea hau ea tšohanyetso ea lehae (911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, 000 Australia) kapa sheba bukana ea rona ea dinomoro tsa tshohanyetso haeba motho a e-ba le feberu e matla ka tšohanyetso (38.9 degrees Celsius / 102.0 degrees Fahrenheit kapa ho feta) e tsamaeang le ho tsekela kapa ho akheha ha a eme, lekhopho le lefubedu le bataletseng le kang la ho chesoa ke letsatsi, ho hlatsa le lets'ollo le nang le metsi, bohloko bo matla ba mesifa, kapa pherekano, kapa pherekano, haholo-holo ha a tsoa leqeba, haholo-holo ha a tsoa leqeba. ho chesa, kapa ho seha ka ho buoa.
2. Hang-hang tlosa tampon leha e le efe, senoelo sa ho ilela khoeli, seponche sa lithibela-pelehi, kapa diaphragm ("Mohloli oa Mohloli"): Haeba hona joale motho a sebelisa tampon ea botšehali, senoelo sa ho ilela khoeli, disc ea ho ilela khoeli, seponche se thibelang pelehi, kapa kepisi ea molomo oa popelo, e tlose hang-hang (kapa u mo thuse ho e ntša ka matsoho a hloekileng a litlelafo). Ho tlosa 'mele osele ho thibela libaktheria ho pompa chefo e ncha ea TSST-1 ea superantigen maling.
3. Boloka tampon e tlositsoeng kapa 'mele osele ka mokotleng o hloekileng oa polasetiki bakeng sa sepetlele: Se ke oa thella tampon ho theosa le ntloana. E behe ka har'a mokotla oa polasetiki o koetsoeng kapa setshelo se hloekileng ebe u se fa baoki kapa basebetsi ba lefapha la maemo a tšohanyetso e le hore lilaboratori tsa microbiology li khone ho hlahisa mofuta o nepahetseng oa baktheria le boemo ba chefo.
4. U SE KE UA phunya linko tse tebileng ka mor'a ho buuoa kapa leqeba le tebileng la opereishene: Haeba motho a e-na le lesela kapa balune e phuthetsoeng ka linkong tsa hae. tsoa mali nkong kapa opereishene ea morao-rao ea sinus, tlohela ho tlosoa ho ea ngakeng ea lefapha la tšohanyetso (ho hula nko ho tsoa lapeng nakong ea ho tšoha ho ka etsa hore ho be le mali a mangata a sa laoleheng), ** ntle le haeba ** e le plug e bonolo ea k'hothone ea lapeng e thellang ntle le ho tsoa mali.
5. Latsa motho ka mokokotlong ho thibela orthostatic syncope le ho tšoaroa ke pelo: Toxic shock syndrome e baka ho tsoa mokelikeli o mongata methapong ea mali, 'me khatello ea mali e theohe tlase haholo. Etsa hore motho a robale a bataletse ka ho feletseng (le ka mohla u se ke ua mo lumella ho ema kapa ho ea ntloaneng, moo bakuli ba bangata ba TSS ba akhehang le ho tsoa likotsi tsa hlooho). Haeba ba ntse ba hlatsa kapa ba otsela, ba behe ka lehlakoreng la bona maemong a ho hlaphoheloa.
6. Hlahloba maqeba ohle a letlalo, maqeba a ho buoa, ho longoa ke likokoanyana, le ho chesoa bakeng sa lifolakha tse khubelu: Sibolla le ho hlahloba likarolo life kapa life tsa morao-rao tsa ho buuoa, maqeba, chesa, liso tsa khōhō, kapa libaka tsa postpartum perineal/cesarean. Hlokomela hore leqeba le bakang staphylococcal TSS hangata le shebahala ** ka thetso le phetse hantle ebile le se na tšoaetso ** (le zero pus kapa redness) hobane chefo e baka ts'oaetso ea tsamaiso ntle le ho thehoa ha pus ea sebakeng seo, athe streptococcal TSS e atisa ho bontša bohloko bo jalang ka potlako, mahlaseli a pherese, kapa necrotizing fasciitis.

flowchart TD
    Start["Feberu e Phahameng ea Tšohanyetso (>= 38.9 C / 102.0 F) PLUS Ho Hlatsa/Lets'ollo, Mahlaba a Matenya a Mesifa, Ho tsekela / Syncope, kapa Lekhopho la ho chesoa ke Letsatsi"] --> CallEMS["1. Letsetsa Litšebeletso tsa Tšohanyetso (911 / 112 / 999) Hang-hang: Phatlalatsa Suspected Toxic Shock Syndrome"]
    CallEMS --> CheckDevice{"2. Na Tampone ea Bosali, Mohope oa ho ilela khoeli, Seponche sa Thibela Kemolo, kapa Diaphragm li teng?"}
    CheckDevice -->|Yes| RemoveDevice["Tlosa Tampon / Mohope Hang-hang ka Matsoho a Hloekileng 'me U boloke ka mokotleng oa polasetiki o Tiisitsoeng bakeng sa Setso sa Sepetlele."]
    CheckDevice -->|No / Nasal or Wound Source| CheckWound{"3. Na Nasal Packing, Ho Buoa Haufinyane, Ho Chesoa, Boemo ba Postpartum, kapa Letlalo le Bohloko bo Tebileng bo Teng?"}
    RemoveDevice --> Position["4. Lala Mokuli ka Mokokotlo (Kapa Sebaka sa ho hlaphoheloa ha o hlatsa/o otsela): Le ka mohla u se ke ua ba lumella ho ema kapa ho Tsamaea."]
    CheckWound -->|Nasal Packing| LeaveNasal["Tlohela ho Pakela Linko tse Tebileng sebakeng sa ho Tlosoa ha Ngaka ea ED ho Thibela Tsoelo-pele ea Mali"]
    CheckWound -->|Wound, Burn, or Postpartum| ExposeWound["Lokolla Liaparo tse Thata ho Lekola ho Ruruha kapa Pherese Bullae (Suspect Streptococcal TSS)"]
    LeaveNasal --> Position
    ExposeWound --> Position
    Position --> Transport["5. U se ke Ua Fana ka letho ka Molomo (NPO) le Lipalangoang ka Potlako bakeng sa Mekelikeli ea IV, Li-Vasopressors, Clindamycin + Beta-Lactam/Vancomycin"]

Staphylococcal TSS vs Streptococcal TSS: Likotsi tse peli tse ikhethang tsa chefo¶

Hoo e ka bang halofo ea toxic shock syndrome kajeno ke eseng ho ilela khoeli, e ama banna, basali le bana ba lilemo tsohle. Tataiso ea meriana e tsoang ho Litsi tsa Tlhokomelo le Thibelo ea Maloetse (CDC, United States) le Mokhatlo oa Mafu a Tšoaetso oa Amerika (IDSA) li khetholla pakeng tsa Staphylococcal TSS (e bakoang ke Staphylococcus aureus) le Streptococcal TSS (e bakoang ke sehlopha se hlaselang sa A Streptoccuscoccus) kapa * pr.

Pathophysiology: "Superantigen" ea baktheria e koetela karolo ea 20 lekholong ea sesole sa hau sa 'mele hang-hang.¶

Ho utloisisa hore na ke hobane'ng ha moatlelete ea lilemo li 19 ea phetseng hantle kapa ngoana ea nang le mocheso o monyenyane a ka tloha a ikutloa a tloaelehile ho ea ho hloka tšehetso ea bophelo bo botle ka nako e ka tlase ho lihora tse 18, ho thusa ho bapisa tšoaetso e tloaelehileng le **superantigen toxin reaction **:

1. Karabelo e tloaelehileng ea 'mele ea ho itšireletsa mafung (0.001 ho 0.01 lekholong ea T-cell activation): Ka tšoaetso e tloaelehileng ea baktheria kapa kokoana-hloko, lisele tse tšoeu tsa mali tse bitsoang antigen-presenting cells li sila kokoana-hloko 'me li hlahisa karoloana e nyenyane haholo ka har'a ** Major Histocompatibility Complex class II (MHC-II)** groove. Ke liperesente tse ** 0.001 ho isa ho 0.01 tsa li-T-cell ** tseo moamoheli oa tsona o ts'oanang hantle le sekhechana se senyane se sebetsang, se hlahisang karabelo e laoloang, e thusang ea 'mele ea ho itšireletsa mafung.
2. Superantigen short-circuit (20 ho 30 lekholong T-cell activation): Staphylococcal TSST-1 le Streptococcal **pyrogenic exotoxin ** ke superantigens. Ho e-na le hore e kene ka hare ho antigen groove e itseng, chefo e sebetsa joaloka tšepe e ka ntle ea tšepe e kopanyang ka ntle ho molek'hule ea MHC-II ka ho toba le ketane e fapaneng ea beta (V-beta) ea li-receptor tsa T-cell, ** ho kenya letsoho ka matla ho fihlela ho 20 ho 30 lekholong ea T-lymphocyte eohle 'meleng oa motho ka nako e le' ngoe *.
3. The Cytokine Storm le Capillary Leak: Ts'ebetso ena e kholo, e sa khetholleng ea T-cell e hlahisa leqhubu le leholo la liprotheine tse bontšang ho ruruha, ho akarelletsa **Interleukin-1 (IL-1) **, **Interleukin-2 (IL-2) **, Tumor Necrosis Factor-alpha) Imma-alpha, TNF-alpha, TNF-alpha, TNF-alpha le TNF-alpha. (IFN-gamma).
4. IL-1 le TNF-alpha li seta botjha hypothalamus ya boko ho etsa hore ka tshohanyetso 39 ho 40.5 degrees Celsius (102.2 ho 105.0 degrees Fahrenheit) fever le ho atolosa methapo ea methapo ka kotloloho ha e ntse e bula mateano a tiileng lipakeng tsa lisele tsa endothelial tse moleng o mong le o mong oa capillary 'meleng.
5. Massive Capillary Leak Syndrome: Lilithara tsa plasma ea mali e tšolohela ho tsoa maling ho ea matšoafong, leboteng la mala, le liseleng tse bonolo (ho fihla ho lilithara tse 8 ho isa ho tse 12 tsa khaello ea mokelikeli ka lihora tse 24), e bakang hypovolemic le ho hasana. tshoso, lefu le matla la ho hema (ARDS), ho hloleha ho matla ha liphio, le kotsi ea sebete sa ischemic.

Lethathamo la tlhahlobo ea bongaka: Matšoao a 6 a Staphylococcal Toxic Shock Syndrome¶

Hobane hangata TSS ea pele e hlokomolohuoa ka phoso e le gastroenteritis e matla ("ntaramane ea mala"), ntaramane, scarlet fever, kapa ho hanana le lithethefatsi, US Centers for Disease Control and Prevention (CDC) e thehile litekanyetso tse thata tsa linyeoe tsa kliniki. Beha TSS hang-hang neng kapa neng ha mokuli a bontša Sudden Fever + Hypotension/Ho tsekela + Lekhopho + Ho Kenyeletsoa ha litho tse 3 kapa ho feta:

1. Feberu e phahameng ea tšohanyetso¶

• Mocheso o matla o nyoloha ka tšohanyetso ho 38.9 degrees Celsius (102.0 degrees Fahrenheit) kapa holimo, 'me o tsamaea le ho thothomela ho matla le malaise. (Tlhokomeliso: Ho bakuli ba nang le Streptococcal TSS e tsoetseng pele ba seng ba le morao ho putlama ha potoloho ea mali, mocheso oa mantlha o ka theoha ka tlase ho 36.0 degrees Celsius / 96.8 degrees Fahrenheit).

2. Diffuse macular erythroderma ("Sunburn-like" rash) le mucosal hyperemia.¶

• The Skin Rash: Lihoreng tse 24 tsa pele, mela, e bataletseng, e bofubelu bo bokhubelu e shebahalang hantle joalo ka ho chesoa ke letsatsi habohloko (kapa lekhopho le lengata le kang scarlet fever) le namela holim'a kutu, molala, mpeng le lipheletsong, hangata le lebile leqebeng kapa ho potoloha leqeba. Ho fapana le bao e seng blanching pherese lekhopho la meningococcal septicemia, TSS erythroderma blanche (e fetoha pherese) ha e totoba ** mme ha e hlohlone kapa hona ho ba bohloko. Letlalong le lefifi, erythroderma ena e pharalletseng e kanna ea shebahala joalo ka lefifi le poteletseng, dusky bronze-plum hue, kapa mofuthu oa letlalo, ho etsa ** tlhahlobo ea mucosal** e hlokehang.
• Membranes ea Beefy-Red Mucous (Conjunctival and Pharyngeal Hyperemia): Hobane chefo e natefisa li-capillaries lerang lohle la mucous, mokuli o ba le:
• Ho tsoa mali, mahlo a mafubelu haholo (conjunctival hyperemia) ntle le ho tsoa ha boladu bo bosehla bo teteaneng.
• Leleme le khanyang la "strawberry" (lemeno le ruruhileng le bofubelu bo khanyang) le melomo e ka hare e khubelu ea beefy le 'metso (oropharyngeal hyperemia).
• Mokokotlo o mohibidu o mohibidu wa bosadi (ka TSS ya ho ilela kgwedi kapa kamora ho pepa).
• Late Skin Peeling (Desquamation ka matsatsi a 7 ho isa ho a 14): Letlapa le botenya ka ho feletseng ho phunya letlalo holim'a ** liatla tsa matsoho, maoto a maoto, menoana le menoana ** ke mokhoa o tummeng oa CDC, empa o etsahala ** 1 ho libeke tse 2 KA MOR'A ho qala ** nakong ea ho hlaphoheloa. Le ka mohla u se ke ua emela hore letlalo le ebole matsohong kapa maotong ho fumana hore TSS e hlobaetsang.

3. Hypotension le orthostatic syncope (Khatello e tlase ea mali)¶

• Khatello ea mali ea Systolic e theoha ka tlaase ho 90 mmHg ho batho ba baholo (kapa ka tlaase ho karolo ea 5 lekholong ho ea ka lilemo baneng), KAPA mokuli o ba le orthostatic hypotension, ho tsekela ho tebileng, ho bona kotopo, kapa ho akheha (syncope) ka mor'a metsotsoana ea ho lula kapa ho ema.

4. Ho kenya letsoho ha litho tse ngata tsa tsamaiso (3 kapa ho feta ho tse latelang tsa 7)¶

1. Gastrointestinal (E teng ho >90 lekholong ea linyeoe, hangata e le letšoao la VERY FIRST): Ho hlaha ka tšohanyetso **lets'ollo le metsi ** le **ho hlatsa khafetsa ** ho qala lihora pele ho hlaha lekhopho. Ke ka lebaka lena TSS e atisang ho fosoa chefo ea lijo kapa kokoana-hloko ea mala.
2. Mesifa (E teng ho> 90 lekholong ea linyeoe): E matla, e akaretsang ** bohloko ba mesifa le bonolo bo feteletseng (myalgia) ** ho pholletsa le mokokotlo, lirope, manamane le mpa, hangata ka mali a phahameng a creatine kinase (CK) le rhabdomyolysis.
3. Mara a Mucous: Mahlo a mafubelu (conjunctivae), 'metso o mofubelu / leleme la fragola, kapa lesela le khubelu la botšehali.
4. Renal (Liphio): Ho theoha ho hoholo ha moroto (oliguria), urea nitrogen e phahameng ea mali (BUN) le serum creatinine (bonyane habeli ho tloaelehileng), kapa lisele tsa boladu tse hloekisitsoeng (pyuria) ka har'a moroto.
5. Hepatic (Sebete): Li-enzyme tse phahameng tsa sebete (AST/ALT kapa bilirubin bonyane tse tloaelehileng habeli) tse bakang jaundice e bobebe.
6. Hematologic (Blood clotting): Ho theoha ha palo ea liplatelete (thrombocytopenia ka tlase ho 100,000/mm3) le ho hasanya intravascular coagulation (DIC) e bakang ho tsoa mareneneng kapa libakeng tsa IV.
7. Sistimi e Bohareng ea Methapo (Boko): Ho ferekana kelellong, pherekano, ho ferekana, delirium, kapa lethargy e feteletseng ntle le ho holofala ha methapo ea kelello, e bakoang ke chefo e bakoang ke cerebral edema le khatello e tlaase ea mali.

Maemo a kotsing e kholo ho feta li-tampon: TSS eo e seng ea ho ilela khoeli e etsa hore motho e mong le e mong a tsebe¶

Le hoja matšolo a tlhokomeliso ea sechaba lilemong tsa bo-1980 a ile a felisa li-rayon tampon tsa polyacrylate tse phahameng ka ho fetisisa le ho fokotsa litekanyetso tsa TSS tsa ho ilela khoeli, **TSS eo e seng ea ho ilela khoeli hona joale e etsa karolo ea 50 lekholong ea linyeoe tsa Staphylococcal TSS le hoo e batlang e le karolo ea 100 lekholong ea linyeoe tsa Streptococcal TSS **:

Mohato ka mohato thuso ea pele ea prehospital ha u ntse u emetse lipalangoang tsa tšohanyetso¶

Mohato oa 1: Ho tlosoa hang-hang ha 'mele oa kantle ho naha ("Prehospital Source Control")¶

Ka ts'oenyeho e amanang le chefo, motsotso o mong le o mong tampon ea colonized, senoelo sa ho ilela khoeli, kapa thibelo ea thibelo ea bokhachane e sala ka hare ho 'mele, Staphylococcus aureus e tsoela pele ho kopanya le ho lokolla TSST-1 superantigen e ncha ho potoloha.

1. Hlatsoa matsoho kapa u roale liatlana tse lahloang.
2. Etsa hore mokuli a paqame betheng kapa sofeng a kobile mangole (le ka mohla u se ke ua lumella mokuli ea nang le bots'oants'o, ea hypotensive a eme holim'a ntloana ho ntša tampon, kaha ho ema ho etsa hore motho a akhehe ka tšohanyetso).
3. Tlosa tampon efe kapa efe, senoelo sa ho ilela khoeli, disc ea ho ilela khoeli, seponche sa lithibela-pelehi, kapa diaphragm ka bonolo ka ho hula khoele kapa ho penya botlaaseng ba senoelo ho roba tiiso.
4. Haeba mokuli a sa tiisehe hore na tampon e ntse e le teng ka hare (kapa haeba khoele e khaohile): Haeba mokuli a falimehile a bile a phutholohile ho etsa joalo, a ka fiela ka bonolo monoana o hloekileng oa index ka har’a kanale ea botšehali ho hlahloba tampon e bolokiloeng e behiloe ka thōko holimo ho vault; ho seng joalo, tlohela tlhahlobo ea ka hare ho ngaka ea lefapha la tšohanyetso (ke mang ea ka e tlosang ka metsotsoana a sebelisa speculum le ring forceps).
5. Sireletsa ntho e tlositsoeng: Beha tampon kapa kopi ka har'a mokotla oa polasetiki o hloekileng oa zip-top o ngotsoeng lebitso la mokuli le nako ea ho tlosoa, 'me u tle le eona ka ambulense.

Mohato oa 2: Boemo ba Hemodynamic le tšireletso ea moea¶

• Supine shock positioning: Boloka mokuli a paqame fatše ka mokokotlo ho etsa hore mali a venous a khutlele pelong le bokong. Haeba ba ikutloa ba le hlooho e bobebe kapa ba akhehile 'me ba se na leqeba leotong kapa ho hema ka thata, ho beha maoto a bona holim'a mosamo ho ka thusa ho tšehetsa bophahamo ba mali.tshoso).
• Taolo ea ho hlatsa le letšollo: Hobane ho hlatsa ho feteletseng le letšollo le nang le metsi li batla li atile qalong ea TSS, boloka beisine le lithaole tse hloekileng haufi le bethe. **Se lumelle mokuli hore a tsamaee ho ea ka kamoreng ea ho hlapela **; Ba thuse ho sebelisa bethe kapa lithaole tse monyang metsi ha ba paqame, 'me ba li phutholle ka lehlakoreng la bona ha ba ntse ba fola ** ha ba hlatsa hore asiti ea mpa e se ke ea huleloa matšoafong.
• Ha ho letho le ka molomong (NPO): Leha mokuli a ikutloa a nyoriloe haholo ke ho lutla ha capillary le lets'ollo, u seke oa fana ka metsi, lino tsa lipapali kapa lipilisi tsa mahlaba a molomo. Lerako la mala ho TSS le ruruhile 'me le na le ischemic (mesenteric hypoperfusion), kahoo metsi a koetsoeng a hlatsa feela,' me mokuli a ka 'na a hloka ho kenngoa ka tatellano e potlakileng kapa ho hlahlojoa ha maqeba a potlakileng ha a fihla sepetlele.

Mohato oa 3: Tsamaiso ea mocheso ntle le li-NSAID¶

• **Tlosa likobo tse boima le liaparo tse thata ** e le hore mocheso o feteletseng oa feberu o ka tsoa letlalong ka tlhaho, ntle le haeba mokuli a ntse a thothomela ka lebaka la mohatsela (e leng hore a sebelise letlapa le le leng le bobebe la k'hothone).
• **Se ke oa itlatsa libate tsa leqhoa kapa lithaole tse metsi tse batang **, tse bakang vasoconstriction ea peripheral le ho thothomela.
• Le ka mohla u se ke ua fana ka ibuprofen, naproxen, kapa aspirin: Li-NSAID li mpefatsa kotsi e mpe ea liphio ho bakuli ba hypotensive TSS, e sitisa ho koala ha platelet ha thrombocytopenia e se e ntse e hlaha, le ho potlakisa tšenyo e hlaselang ea sehlopha sa A Streptococcal soft-tissue.

Ho etsahalang lefapheng la tšohanyetso: Hobaneng ha Clindamycin e le bohlokoa ho TSS¶

Ho utloisisa mokhoa oa ho tsosolosa sepetlele oa litšiea tse tharo bakeng sa toxic shock syndrome ho thusa bakuli le babuelli ba malapa ho buisana ka ho hlaka le lihlopha tsa maemo a tšohanyetso:

Pilara ea 1: Ho tsosolosa mokelikeli o matla ka methapo le li-vasopressors¶

Hobane TSS e baka capillary leak syndrome e kholo, methapo ea mali ea mokuli e moholo e ka lutla 6 ho 12 lithara (1.5 to 3 gallon) ea mokelikeli ka har'a linama tse potolohileng lihoreng tse 24 tsa pele. Lingaka tsa maemo a tšohanyetso hang-hang li beha mela e 'meli e meholo e nang le methapo e meholo' me li kenya li-boluses tse potlakileng tsa **metsi a crystalloid a leka-lekaneng (a kang lactated Ringer solution kapa 0.9% saline e tloaelehileng ea saline, ho qala ka 30 milliliters ka kilogramme ea pele ea 1 ho lihora tsa 3) **, e lateloa ke intravenous intravenous * norepinephrine e ntse e le "vanorepinephrine" ho sa tsotellehe khatello ea mali * norepinephrine. ho kenya mokelikeli.

Pilara ea 2: Lithibela-mafu tse kenang ka har'a methapo tse peli tse kenyelletsang protheine-synthesis toxin blocker (Clindamycin kapa Linezolid)¶

Ho phekola toxic shock syndrome ho hloka leano le fapaneng ka ho felletseng la lithibela-mafu ho feta ho alafa tšoaetso e tloaelehileng:

• Hobaneng lithibela-mafu tsa cell-wall (penicillins, cephalosporins, vancomycin) feela HA LIA lekana: Lithibela-mafu tse tloaelehileng tsa bactericidal tse kang cefazolin, nafcillin, kapa vancomycin li bolaea libaktheria ka ho phatlola mabota a lisele tsa tsona tse ka ntle, tse hlileng li ka lokollang thotobolo ea ka tšohanyetso ea chefo e entsoeng esale pele, le maemong a phahameng a baktheria*" Eaglec**" Eagleccuss" *Streptocus e emisa ho sebetsa hang ha libaktheria li emisa ho arohana ka potlako.
• Ho eketsa Intravenous Clindamycin (kapa Linezolid) hang-hang ho koala fektheri ea chefo: Clindamycin (le linezolid) e tlama ka ho toba 50S ribosomal subunit ka hare ho Staphylococcus aureus le Streptococcus pyogenes, -halting bacteria ea streptococcus le streptococcus streptococcus STR exotoxins nakong ea metsotso ho sa tsotelehe hore na libaktheria li ntse li arohana.
• Ka hona, litataiso tsa machaba li laela ho kopanya Intravenous Clindamycin (ho koala tlhahiso ea chefo) PLUS Intravenous Vancomycin kapa Daptomycin (ho koahela MRSA) le Beta-Lactam e kang Piperacillin-Tazobactam, Meropenem, kapa Nafcillin/Penicillin G ho fihlela meetlo e khutla.**

Pilara ea 3: Taolo e hlakileng ea mohloli oa ho buoa le Intravenous Immunoglobulin (IVIG)¶

• ** Ho hlahloba sekoti se seng le se seng le sekheo:** Lingaka tsa maemo a tšohanyetso li etsa tlhahlobo e felletseng ea pelvic speculum (ho thibela tampon ea bobeli e patiloeng e lebetsoeng), ho tlosa sephutheloana leha e le sefe sa nko, le ho bitsa litsebi tsa ho buoa ho bula, ho senya le ho hlatsoa leqeba leha e le lefe la ka mor'a ho buuoa, leqeba, kapa libaka tseo ho belaelloang hore li teng. necrotizing fasciitis.
• Intravenous Immunoglobulin (IVIG): Ho bakuli ba nang le Streptococcal TSS e matla kapa Staphylococcal TSS ea refractory ba lulang ba maketse ho sa tsotellehe maro le clindamycin, lingaka tsa tlhokomelo e matla li kenya motho e kopantsoeng Intravenous Immunoglobulin (IVIG), e nang le litekanyetso tse phahameng tsa li-antibodies tse thibelang mali le ho kopanya mali ka ho toba. pele ba ka hlahisa lisele tsa T tse ngata.

Thibelo: Mokhoa oa ho fokotsa kotsi ea TSS ea ho ilela khoeli le maqeba¶

Le hoja e se nyeoe e 'ngoe le e' ngoe ea TSS e ka thibeloang, ho latela mekhoa ea bohloeki e thehiloeng bopaking ho theola haholo kotsi ea ho ilela khoeli le lisebelisoa tse amanang le staphylococcal TSS:

• Sebelisa lintlha tse tlase haholo tsa ho monyela tampon tse hlokahalang bakeng sa phallo ea hau ea hajoale: Tampon absorbency e tloaelehile lefatšeng ka bophara (Leseli, Kamehla, Super, Super Plus, Ultra). Ho sebelisa tampon e matla haholo ka letsatsi la phallo e khanyang ho omella ebe ho baka maqeba a manyane ka har'a mucosa ea botšehali ha e ntse e khothaletsa kholo ea baktheria.
• Fetola lipompong lihora tse ling le tse ling tse 4 ho isa ho tse 6 ('me le ka mohla u se ke ua siea e le 'ngoe ka nako e telele ho feta lihora tse 8): Phapanyetsano pakeng tsa lipompo le li-sanitary pads (haholo-holo bosiu bo le bong ha u robetse lihora tse fetang 6 ho isa ho tse 8).
• Hlapa matsoho ka sesepa le metsi pele le kamora ho kenya kapa ho ntša tampon, senoelo sa ho ilela khoeli, kapa thibelo ea thibelo ea bokhachane: Hobane karolo ea 30 lekholong ea batho ba jara Staphylococcus aureus matsohong le linkong, ho hlapa matsoho pele ho phutholla tampon kapa ho tšoara kopi ea ho ilela khoeli ho thibela ho fetisa S. aureus ho tloha menoaneng ea hau ho ea sesebelisoa.
• Belisa le ho hloekisa likotlolo tsa ho ilela khoeli tse ka sebelisoang hape lipakeng tsa nako ebe u li tšolla ka mor'a lihora tse ling le tse ling tse 4 ho isa ho tse 8: Liphuputso tsa Clinical microbiology li tiisa hore Staphylococcus aureus e ka etsa biofilm le ho hlahisa TSST-1 ka har'a linoelo tsa silicone tse ka sebelisoang hape tsa ho ilela khoeli haeba li tloheloa nako e telele haholo kapa li hlatsuoa feela ka metsi a pompo ntle le ho belisa lipakeng tsa ho ilela khoeli.
• Le ka mohla u se ke ua sebelisa li-tampon kapa linoelo tsa ho ilela khoeli Hape haeba u kile ua tšoaroa ke Staphylococcal TSS: Ho fihlela ho 30 lekholong ea bakuli ba pholohang TSS ba tla hlaseloa ke tlhaselo e iphetang nakong ea ho ea khoeling e latelang haeba ba sebelisa li-tampon hape, hobane TSST-1 superantigen e senya mekhoa e tloaelehileng ea ho itšireletsa mafung ea B-cell le ho thibela likokoana-hloko tse ngata tsa ST. Mang kapa mang ea nang le nalane ea TSS o tlameha ho sebelisa liphaephe tsa kantle tsa bohloeki bophelo bohle feela.

Lipotso tse botsoang khafetsa¶

Mehloli e hlahlobiloe¶

• Litsi tsa Taolo le Thibelo ea Mafu (CDC, United States): *Toxic Shock Syndrome (Tse ling Ntle le Streptococcal) Tlhaloso ea Taba ea 2011 * le Streptococcal Toxic Shock Syndrome (STSS) 2010 Case Definition le Clinical Guidance.
• Mokhatlo oa Mafu a tšoaetsanoang oa Amerika (IDSA, United States): Itloaetse Tataiso ea Tlhahlobo le Tsamaiso ea Mafu a Letlalo le a Soft: Staphylococcal le Streptococcal Toxic Shock Syndrome.
• Setsi sa Naha sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE) le Setsi sa Ts'ireletso ea Bophelo sa UK (UKHSA, United Kingdom): Ho belaelloang hore ke Sepsis le Sehlopha se Hlaselang Lefu la Streptococcal (iGAS): Ho Tseba, Tlhahlobo, le Tsamaiso ea Pele.
• Tlhahlobo ea Naha ea Tlhokomelo ea ho Chesa le Mokhatlo oa Brithani oa Burn (United Kingdom): Litaelo tsa Tsamaiso ea Pediatric Burn Toxic Shock Syndrome.
• Nonfoux L, Chiaraviglio L, et al. (Applied and Environmental Microbiology): Kameho ea Li-tampone tse Rekisitsoeng Hajoale le Likopi tsa ho Hlapa ho Kholo ea Staphylococcus aureus le Toxic Shock Syndrome Toxin 1 Production In Vitro.
• Lappin E, Ferguson AJ (The Lancet Infectious Diseases): Gram-positive toxic shock syndromes.

Litataiso tse amanang¶

• Tlhokomelo ea sepsis le septic shock le thuso ea pele ea tšohanyetso
• Necrotizing fasciitis (tšoaetso e jang nama) le lifolakha tse khubelu tsa cellulitis
• Thuso ea pele e tšosang le boemo ba ho putlama ha potoloho ea mali
• Taolo ea mali a nko (epistaxis) le tlhokomelo ea ho paka linko
• Ho chesa le ho chesa ho pholile le ho roala thuso ea pele
• Linomoro tsa maemo a tshohanyetso ho ea ka linaha