インフルエンザ流行中に発症したトキシックショック症候群の１例

Abstract

Recently, toxic shock syndrome (TSS) has been described following Staphylococcus aureus infections in various clinical settings, e.g., surgical wound infections, skin lesions and respiratory tract infections. In 1987, Sperber and MacDonald reported TSS during an influenza outbreak. We report a 42-year-old man who presented with a high fever, watery diarrhea, sore throat, cough, and diffuse erythroderma during an outbreak of influenza in 1993. On the tenth hospital day, the patient developed profound shock with severe metabolic acidosis and loss of consciousness. He fulfilled the Centers for Disease Control confirmed case definition for toxic shock syndrome. Though neither TSST-1 nor enterotoxin was detected, his feces grew out Staphylococcus aureus. The patient required massive infusion of half saline and administration of catecholamines to recover from shock. Staphylococcal pneumonia is a well-recognized complication of influenza. This patient showed no evidence of pneumonia. However, MacDonald noted that TSS may occur during influenza without overt clinical evidence of suppurative bacterial respiratory tract infection. We must recognize TSS as a rare but severe complication of influenza.