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Fever, cough, skin rash associated with multi-system damage

The performance of the majority of leukocytes and lymphocyte count increased, and can be abnormal lymphocytes. Course of the disease and the patients with normal urine output and renal function was normal, and the blood does not match. (3) Identification of severe acute hepatitis. Than acute onset of severe hepatitis, jaundice rapidly deepened, serious liver damage, evidence of bleeding tendency, often liver atrophy. In this case liver, jaundice, direct bilirubin, rather than hepatocellular jaundice, mild hepatic dysfunction, hepatitis B 3-series examination was normal, so doctors do not consider the C: patients usually physical health, are mainly high fever, rash , liver and kidney dysfunction, physical examination found that the skin is broken right foot between the toes, combining characteristics of blood, considered as septic shock caused by bacterial infection. Although the blood culture-negative, people may be related to the use of antibiotics before hospital. Treatment is focused on positive anti-infection, early enough to use hormones. And strengthening the symptomatic treatment of nutritional support. Prevent complications such as DIC and so on. Protection of important organs. Dr D: patients with a high fever, cough, diarrhea, 1d 3d people with homes. People at the hospital continued high fever, repeated vomiting, diarrhea, diffuse skin, scarlet-like body changes, conjunctival hyperemia, hand, foot and tongue, pharynx, blood blisters, and a thousand mouth, irritability, hypotension, shock vague consciousness performance. Examination: the skin, sclera jaundice, coarse breath sounds in both lungs, news and a little moist babble sound. Liver and spleen ribs just touched. Right foot toe 3,4 smell a small amount of skin ulceration and oozing yellow fluid, blood, liver and kidney dysfunction, blood culture, Widal reaction negative. After the course has the following characteristics: (1) persistent fever; 』, China Medical 2oo1 44 of Volume 3 (Total 496) (2) to the main trunk of the scattered red rash; (3), hypotension was , dry mouth, irritability and other symptoms; (4) multi-system dysfunction, such as vomiting and diarrhea, pharyngeal tongue ulcers, gastrointestinal bleeding liver and kidney dysfunction, thrombocytopenia, vague consciousness; (5) after the onset of hand, foot and blood blister , 1 week after peeling; (6) blood culture, Widal reaction and other tests ruled out typhoid fever, epidemic hemorrhagic fever and other possible, it should be diagnosed as toxic shock syndrome (TSS). The major pathogens Staphylococcus aureus and streptococcus,[link widoczny dla zalogowanych], the former usually parasitic on skin, mucous membrane, which feed on the pharynx, soft tissue. Through the examination of the cases, the basic rule out intra-abdominal infections, such as liver abscess, intestinal infection, inflammation in the lung disease hospital after the person, so the first consideration for the secondary infection. Pathogenesis of this disease and related superantigen, most bacterial superantigen toxic bacterial outer cable, usually a small amount of super-antigen biological defense mechanism for the mobilization is beneficial in small cells may activate the body's physiological amount of cytokines, conducive to the body's defense, but if a large number of super-antigen into the body will produce excessive cytokines, such as tumor necrosis factor (TNF),[link widoczny dla zalogowanych], interleukin 1 (IL-1), leading to hypotension and multi-system damage. Staphylococcus aureus,[link widoczny dla zalogowanych], the bacteria through the release of toxins (toxic shock syndrome toxin 1, TSST1) acting on the body, causing symptoms and signs are not appropriate for all infections can produce TSST-1 strains in patients could lead to TSS , is only part of the lack of resistance on the TSST1 was suffering from low immunity TSS. Compared with TSS caused by Streptococcus, Staphylococcus aureus, often heavier TSS caused by vomiting, diarrhea and other symptoms, and severe pain and rapidly progressive edema is less common, Miao hyperlipidemia relatively low incidence and mortality . Performance may be due to early onset non-specific, or limited to the level of physician awareness and reported the incidence of TSS is not high in most patients before the use of antibiotics in the diagnosis, so the low rate of positive blood culture. TSS is currently still use the high-dose treatment of antibiotics, usually lactam antibiotics, or Jia Kelin neomycin (clindamycin) and related drugs. The disease mainly differentiated from the following diseases: (1) epidemic hemorrhagic fever. The main manifestations were fever,[link widoczny dla zalogowanych], neck, chest, skin congestion, multiple organ dysfunction, especially impaired renal function-based, typical cases of fever, shock,[link widoczny dla zalogowanych], oliguria, polyuria and other performance; (2) Kawasaki disease. More common in children, characterized by sustained high fever, eye hyperemia, acral swelling, fingertip desquamation, some patients with coronary artery inflammation, 25 patients with streptococcal infection related; (3) Staphylococcus aureus, streptococcus toxic shock syndrome . Staphylococcus aureus is scarlet fever-like rash, and streptococcal infections are rash-like, toxic shock syndrome Staphylococcus aureus positive blood culture rate is very low, but the streptococcal toxic shock syndrome, the positive rate of 50 or more, and mortality will be significantly higher; (4), thrombotic thrombocytopenic purpura in five of the disease symptoms, including fever, psychosis, thrombocytopenia, bleeding tendencies, jaundice and anemia, kidney damage and identify the main points for the laboratory tests, such as abnormal