A carregar...
Publicação
Síndrome do choque tóxico estreptocócico : a propósito de dois casos clínicos
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 771.84 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Resumo: O Síndrome do Choque Tóxico Estreptocócico habitualmente define-se pelo isolamento do agente Streptococcus do grupo A colhido de um local habitualmente estéril em conjunto com o início súbito de choque e lesão de órgão.
Entre os anos de 1980 e 2000 a incidência do Síndrome do Choque Tóxico Estreptocócico sofreu um grande aumento, essencialmente devido a diversos fatores que contribuíram para um aumento da virulência da bactéria: proteínas de superfície, produção de toxinas e ainda fatores do hospedeiro. Como fatores de risco importantes para o desenvolvimento de doença invasiva pelo Streptococcus pyogenes, em crianças saudáveis, destaca-se: a varicela, uso de AINEs e os traumatismos minor.
As portas de entrada mais frequentes deste agente são a pele e as mucosas, sendo que nalguns casos raros pode ocorrer como complicação de faringite. Desde a sua descrição inicial, avanços consideráveis no conhecimento relativo à patogénese desta patologia foram adquiridos. No entanto, os mecanismos patogénicos da Síndrome do Choque Tóxico Estreptocócico ainda não são totalmente conhecidos. Foi sugerida a associação com as exotoxinas pirogénicas, também responsáveis pelo exantema da escarlatina, que estimulam a proliferação e ativação de linfócitos T. Esta ativação tem com consequente produção de citocinas, culminando em choque e necrose tecidular.
A sua evolução é, muitas vezes, extremamente rápida, sendo necessário um elevado grau de suspeita diagnóstica e início atempado da terapêutica adequada, assim como abordagem cirúrgica da infeção dos tecidos moles, quando indicado.
Neste trabalho são expostos e discutidos dois casos clínicos de choque tóxico por Streptococcus pyogenes, que diferem na idade do doente, fatores predisponentes, manifestações clínicas e evolução do quadro.
São apresentados estes casos pela sua atualidade, gravidade das situações clínicas e questões que levantam.
Abstract: Streptococcal Shock Syndrome is defined by the isolation of Streptococcus Group A agent from a habitually sterile site in addiction to a sudden onset of shock and organ damage. Between 1980 and 2000, the incidence of Streptococcal Shock Syndrome increased significantly, mainly due to an increase in bacteria's virulence (surface proteins and toxin production) and host factors. Important risk factors for the development of Streptococcus pyogenes invasive disease in healthy children include chickenpox, use of NSAIDs and minor trauma. The most frequent way of infection is through the skin and the mucous membranes, althought, in some rare cases, it may occur as a complication of pharyngitis. Since the original description, considerable advances in its pathogenesis knowledge have been acquired. However, the pathogenic mechanisms of Streptococcal Shock Syndrome are not yet fully understood. The association with pyrogenic exotoxins, also responsible for Scarlet Fever exanthema, has been suggested to stimulate the proliferation and activation of T lymphocytes. This activation leads to cytokines production, culminating in shock and tissue necrosis. The evolution is often extremely rapid, requiring a high degree of diagnostic suspicion and quick initiation of appropriate therapy, as well as a surgical approach in case of soft tissue infection. In this thesis two clinical cases of toxic shock by Streptococcus pyogenes are exposed and discussed, which differ in patient's age, predisposing factors, clinical manifestations and evolution. These cases are presented by its actuality of the cases, severity and complications that have aroused.
Abstract: Streptococcal Shock Syndrome is defined by the isolation of Streptococcus Group A agent from a habitually sterile site in addiction to a sudden onset of shock and organ damage. Between 1980 and 2000, the incidence of Streptococcal Shock Syndrome increased significantly, mainly due to an increase in bacteria's virulence (surface proteins and toxin production) and host factors. Important risk factors for the development of Streptococcus pyogenes invasive disease in healthy children include chickenpox, use of NSAIDs and minor trauma. The most frequent way of infection is through the skin and the mucous membranes, althought, in some rare cases, it may occur as a complication of pharyngitis. Since the original description, considerable advances in its pathogenesis knowledge have been acquired. However, the pathogenic mechanisms of Streptococcal Shock Syndrome are not yet fully understood. The association with pyrogenic exotoxins, also responsible for Scarlet Fever exanthema, has been suggested to stimulate the proliferation and activation of T lymphocytes. This activation leads to cytokines production, culminating in shock and tissue necrosis. The evolution is often extremely rapid, requiring a high degree of diagnostic suspicion and quick initiation of appropriate therapy, as well as a surgical approach in case of soft tissue infection. In this thesis two clinical cases of toxic shock by Streptococcus pyogenes are exposed and discussed, which differ in patient's age, predisposing factors, clinical manifestations and evolution. These cases are presented by its actuality of the cases, severity and complications that have aroused.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Síndrome do choque tóxico estreptocócico Pediatria Streptococcus pyogenes