Question

An unresponsive 20-year-old female college student is brought to the emergency room. Respiratory rate is 50/min and systolic blood pressure is 60mm Hg. She is intubated and transferred to the ICU. The patient's roommate reports that the patient had been feeling ill for about 2 days and had been experiencing diarrhea. The physical examination reveals lungs that are clear; she has an elevated body temperature of 39.8°C, and there is a desquamation of the skin around the fingernails and underlying toes. A malodorous tampon is removed. Culture and Gram stain is obtained from exudate material from the cervix. Blood is drawn for a CBC and for coagulation studies. The CBC is significant for an elevated white blood cell count with a pronounced left shift and a platelet count that is significantly decreased. Prothrombin time is abnormally high. The Gram stain is significant for Gram-positive cocci in clusters. The culture is positive for Gram-positive cocci that are beta-hemolytic on 5% sheep blood agar, catalase-positive, and coagulase-positive. Refer to the image. This patient is diagnosed as having menstrual toxic shock syndrome due to what infection? Answer Choices: A Streptococcus agalactiae B Clostridium perfringens C Bacillus cereus D Streptococcus intermedius group (millerii) E Streptococcus pyogenes F Staphylococcus aureus

Answer 1

The patient is diagnosed with menstrual toxic shock syndrome, which is caused by the bacteria Staphylococcus aureus. Symptoms are caused by a toxin produced by these bacteria, and can be severe and life-threatening. Removal of the source of infection (e.g., a tampon), antibiotics, and supportive care are key treatments.

Step-by-step explanation:

The patient in this scenario is suffering from menstrual toxic shock syndrome (TSS), which is most commonly caused by the bacterium Staphylococcus aureus. The Gram stain and culture information, along with the recent use of a tampon, aligns with this diagnosis. Staphylococcus aureus bacteria can produce a potent toxin called toxic shock syndrome toxin-1 (TSST-1), which is a superantigen that can cause a massive inflammatory response.

In many cases, TSS is associated with prolonged tampon use, which creates a favorable environment for the bacteria to proliferate and release the toxin. After the toxin gets into the bloodstream, it can cause symptoms like high fever, low blood pressure, and signs of multi-organ dysfunction such as the decreased platelet count and elevated prothrombin time seen in this patient. It also leads to a notable increase in white blood cells as the body tries to combat the infection. The condition is a medical emergency and can be fatal if not promptly treated.

The removal of the source of the infection - in this case, the tampon - along with administration of antibiotics and supportive care, are key components of treatment for this syndrome. This helps fight the infection and manage symptoms. The prognosis of the condition can vary depending on factors such as the patient's overall health status, the speed of diagnosis, and the promptness of initiation of appropriate treatment.

Learn more about Toxic Shock Syndrome