Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
-
Letter Case Reports
Septic shock due to Yersinia enterocolitica after autologous transfusion.
-
An unusual acute hypotensive syndrome has been observed in association with administration of trimethoprim-sulfamethoxazole (TMP-SMZ) to patients with human immunodeficiency virus (HIV) infection. In the 11 cases that have been reported, the syndrome differs from classic anaphylaxis and resembles septic shock. Mediation by tumor necrosis factor (TNF) has been hypothesized, but the mechanism has not been characterized with cytokine assays, and no invasive hemodynamic measurements have been reported. We describe a case of recurrent hyperdynamic shock--without classic features of anaphylaxis, without detectable IgE antibodies against TMP or SMZ, and without detectable levels of TNF--involving an HIV-infected patient rechallenged with TMP-SMZ.
-
Letter Case Reports
Iatrogenic meningitis due to Streptococcus salivarius following a spinal tap.
-
Review Case Reports
Toxic shock syndrome complicating influenza A in a child: case report and review.
Despite extensive literature on toxic shock syndrome, reports of its manifestations in children remain relatively uncommon. Similarly, toxic shock syndrome in association with influenza B or influenza-like illness has been reported in 12 patients, but it has been reported to occur following influenza A in only two patients to date. We report a third case of toxic shock syndrome in a child with influenza A and review the association between epidemic influenza and toxic shock syndrome ("the Thucydides syndrome").
-
Clostridial infections cause a wide variety of dramatic infections and intoxications. In each case the major virulence factors are extracellular toxins. Clostridium perfringens produces potent exotoxins, which are its major virulence factors. theta Toxin, a thiol-activated cytolysin, causes the clear zone of hemolysis around colonies on blood-agar plates, suppresses myocardial contractility ex vivo, and induces shock within 1 to 2 hours in vivo. ⋯ These data suggest that theta toxin in high concentrations is a potent cytolysin and promotes direct vascular injury at the site of infection. At lower concentrations theta toxin activates PMNs and endothelial cells, and in so doing promotes vascular injury distally by activating adherence mechanisms. The rapid tissue necrosis associated with C. perfringens infection may be related to progressive vascular compromise orchestrated by dysregulated host-cell responses induced by theta toxin.