Staphylococci - extremely common representatives of the microflora of the skin and mucous membranes of man. As pathogens were found among the first. Staphylococci cause many
infections, including superficial and deep purulent infection, intoxication, urinary tract infection. In the US, they are the leading cause of sepsis, post-operative wound infections and infections
endoprosthesis. Among the causative agents of hospital infections they are second in frequency space. Besides
of staphylococci - one of the leading causes of bacterial food poisoning.
The most important person for staphylococcus, causing various diseases, is Golden
staph - Staphylococcus aureus - resistant, easy to acquire resistance to antimicrobial
preparations of pathogen infection. Other staphylococci, in particular - Staphylococcus epidermidis -
Staphylococcus epidermidis, have a tendency to foreign materials (endoprostheses) and, increasingly,
become agents of hospital infections, especially in immunocompromised patients. Another aureus, Staphylococcus saprophyticus, - common causative agent of urinary tract infections.
Staphylococcal toxic shock
Toxic shock - an acute, life-threatening toxicity, which manifests
fever, hypotension, rash, multiple organ failure and, in the beginning of the period
recovery, peeling of the skin. Toxic shock was first described in 1978, but attracted
everyone's attention only after 2 years - due to a large outbreak among women who used the
tampons during menstruation. The disease is widespread enough (1 case per 100 000 women
of childbearing age in the year). Probably, however, it is more common than diagnosed. Approximately half of the cases are not linked to the use of tampons and distributed between men and women of all ages. Toxic shock clinical picture is always the same, regardless of its cause.
Toxic shock causing toxins produced by Staphylococcus aureus. is he
often occurs in young people, as more than 90% of adults have antibodies to the calling of his
Most often toxic shock occurs duringmenstruation, but can develop as a complication of barrier contraception, postpartum period, infected abortion, gynecological surgery, skin injuries (including chemical and thermal burns, insect bites, chicken pox and operating wounds). After surgery toxic shock develops in a period of several hours to several weeks. For its origin is not required clinically severe staphylococcal infections, quite stafilokkok carrier that can produce toxins. Therefore, signs of inflammation at the site of formation of the toxin does not always happen. On the other hand, toxic shock syndrome may develop against staphylococcal infections muscles, bones, joints and respiratory tract.
Toxic shock begins acutely, with a highfever, nausea, vomiting, diarrhea, abdominal pain, muscles, throat, headache. Dizziness alone or when standing up - a sign of decreased blood pressure. In the first 2 days of the disease there is a characteristic spotted rash usually generalized. The rash can pass quickly or persist for a long time. Often there are disorders of consciousness. In many cases, there are redness of the eyes and mucous membranes of the oropharynx and swelling, half of the patients - red strawberry tongue.
Early symptoms of toxic shock syndrome are inwithin a few days, after which the leading manifestations are consequences of arterial hypotension (blood pressure lowering) - disorders of the kidneys and the heart, massive edema, etc. About a week later the skin starts peeling trunk, face and extremities. On the feet, the palms and fingers of the skin exfoliated. Frequent late complication - gangrene of the extremities, muscle weakness, reversible loss of hair and nails, neurological and psychiatric disorders.
toxic shock treatment consists in removingthe source of infection, fluid therapy and antibiotics are active against Staphylococcus aureus. Required inspection and washing of fresh surgical wounds, even in the absence of signs of inflammation.
More than half of the patients who underwenttoxic shock, antitoxic immunity is not produced. The carriage of Staphylococcus aureus in the vagina can be permanent or recurrent in nature, so frequent and repeated cases of toxic shock.
Staphylococcal scalded skin syndrome (scalded skin syndrome)
Scalded skin syndrome (Ritter's disease) causes zolotistyys tafilokokk,
generating certain types of toxins. Ill they mainly infants and young children
age. After 5 years of scalded skin syndrome is rare, but on the background of severe diseases (eg, renal insufficiency) or immunodeficiency. This is due to generation of antitoxic immunity and may decrease sensitivity to these toxins. Most adults have antibodies to staphylococcal toxins. Development scalded skin syndrome is preceded by a staphylococcal infection, often - purulent rhinitis.
scalded skin syndrome often begins withHeaded pain, chilling, aching muscles, perhaps - vomiting, diarrhea. After that, there is a red rash punctulate - first around the eyes and mouth, then spreads to the trunk and limbs. The rash is particularly pronounced in large skin folds. The skin feels like sandpaper, painful when touched. Frequent swelling around the eyes, children - irritability or lethargy, low-grade fever. After a few hours or days begins detachment of the upper layers of the skin. The skin is like a piece of tissue paper; the slightest pressing (even for apparently healthy areas) causes detachment. After about 48 hours deprived skin surface layer dries and begins peeling. The disease lasts about 10 days.
The disease can cause dehydration and sepsis that yaalyaetsya cause of death.
Treatments include antibiotics active against staphylococci, infusion
therapy and careful care of the affected skin.
Food poisoning caused by Staphylococcus
The disease begins 2-6 hours aftereating contaminated food with the sudden appearance of nausea, vomiting, cramping abdominal pain, diarrhea. Foodborne diseases cause Staphylococcus aureus toxins formed in the contamination of food and they have got together with her in the gastrointestinal tract. As the body receives a ready-made toxin, the disease develops rapidly. Staphylococcal toxins are kept heated to such a temperature at which themselves are killed staphylococci. The incidence is quite high; it is somewhat higher in the summer than at other times of the year. The reason most often serve meat dishes and cakes with custard - perhaps because staphylococci, being resistant to high concentrations of protein, salt and sugar, thrive in these products without being competitive. Outbreaks are usually associated with the consumption of food, long shelf life at room temperature. Food is often shatters due to the inventory of pollution and poor personal hygiene persons, it is prepared.
Infections of the skin and soft tissues
Staphylococcus aureus - the most common pathogenskin and soft tissue infections. These infections may be primary or secondary, that is developing on the background of another illness. It is their usually own microflora of the patient.
A range of infections - from mild to severe, life-threatening - begins with the hair follicles.
Folliculitis - inflammation of the upper parts of the hair follicle - appears yellowish pustules,
surrounded by a narrow red corolla. To speed recovery, topically applied antiseptics; at
Severe cases may require antibiotics (topically or orally). Furuncle - acute purulent
inflammation of the hair follicle and the surrounding tissues. In the center of the boils formed
necrotic core. Favourite localization - the buttocks, face, neck. On palpation boil tight and painful. Fever and frequent violation of general condition. To speed recovery and prevent the formation of scar often requires opening and drainage, as well as antibiotics. If not eliminated S. aureus carriage, abrasions can be repeated. A carbuncle is formed at the confluence of several boils to form a zone of diffuse soft tissue inflammation. A favorite okalizatsiya - back of the neck, shoulders, buttocks, thighs. The disease occurs with high fever and impaired general condition. It is more common in men - middle-aged or older. Autopsy, drainage and antibiotics are required. Staphylococcus aureus - the most common causative agent of paronychia (inflammation of periungual tissues).
Staphylococcus aureus also causes bullous impetigo - superficial skin infection,
occurring mostly in children. Under the action of detachment occurs eksfoliatin
superficial layer of the skin and blistering1.2 cm in diameter. customary causative agent (nebulleznogo) impetigo usually serves Streptococcus pyogenes, but in this case, Staphylococcus can cause superinfection. With a limited defeat quite topical antibiotics; in advanced or proceeding with enlarged lymph nodes - antibiotics prescribed inside.
The causative agent of cellulitis - diffuse inflammationsubcutaneous tissue - Staphylococcus aureus is less than Streptococcus pyogenes. Staphylococcal abscess usually occurs as a wound infection - after injuries and operations, rather than at small and inconspicuous skin lesions. In the treatment of cellulitis advisable to use antibiotics, active against a Streptococcus pyogenes, and against Staphylococcus aureus. In contrast, Streptococcus pyogenes, Staphylococcus aureus is not an agent of erysipelas - superficial infection of the skin and subcutaneous tissue, the hallmark of which are clear boundaries and raised edges of the affected area.
Respiratory Tract Infections
Staphylococcus aureus gets into legie through blood or if it enters the lungs
microflora of the upper respiratory tract. Staphylococcal pneumonia - a relatively rare, but serious
infection, which is characterized by chest pain,shortness of breath, intoxication. It almost always occurs in the presence of risk factors (unfavorable epidemiological situation, the carriage of Staphylococcus aureus in the upper respiratory tract, immunity easing). For carriage of Staphylococcus aureus predispose hospitalization, antibiotics, staying in the homes of the elderly and disabled. Most often, staphylococcal pneumonia develops after tracheal intubation or a viral respiratory infection. The influenza virus promotes colonization of the upper respiratory tract Staphylococcus aureus.
Staphylococcal pneumonia may develop in infective endocarditis of the right heart
(Especially widespread among injecting drug users) and suppurative thrombophlebitis, often
complicating catheterization veins. Pneumonia begins acutely - chest pain and shortness of breath. Sputum can not be; but on the chest radiograph is usually seen multiple focal shadows - a characteristic feature of this pneumonia. Empyema - a common consequence of staphylococcal pneumonia, and without giving a lot of complications.
Staphylococcus aureus is sometimes the major microorganisms found in smears from the pharynx in
angina patients, especially children. Staphylococcal sore throat may be accompanied Scarlatiniform
rash and severe intoxication (as in toxic shock). Intoxication is typical for
staphylococcal tracheitis. Staphylococcus aureus - a frequent pathogen of chronic sinusitis, which usually result from illiterate antimicrobial therapy, which led to the formation of antibiotic-resistant species.
Staphylococcal infection of the central nervous system
Staphylococcus aureus gets into the centralnervous system via the blood or surrounding tissue. It is one of the main causative agents of brain abscesses, especially those which result from septic emboli. Usually this happens in infective endocarditis of the mitral and aortic valve. Such abscesses - often small, numerous, scattered throughout the brain. brain abscess may develop as a result of the spread of infection from the paranasal sinuses (frontal, sphenoid, trellised labyrinth) or soft tissue (after penetrating injuries and surgical interventions). Purulent meningitis may develop on the background of staphylococcal abscess of the brain, or be the result of popadenii aureus in blood. In the latter case, abscesses in the survey did not find.
Staphylococcus aureus causes most other microorganisms and other intracranial volume
infectious processes. Subdural empyema - usually the result of the spread of staphylococcal osteomyelitis focus of the skull bones, sinusitis, wound infection (in operations and injuries). Subdural empyema is often accompanied by meningitis, epidural abscess, thrombophlebitis of superficial veins of the brain and cerebral venous sinus thrombosis. The main symptoms: fever, headache, vomiting, symptoms of irritation of the meninges. As the progression of the infection develops swelling and often cerebral infarction, there are disorders of consciousness, seizures, focal neurological symptoms. The patient's condition can deteriorate very quickly. The need for urgent surgery, drainage and antibiotics.
Staphylococcus aureus - the most common causative agent of spinal epidural abscess,
which usually develops as a complication of spinal osteomyelitis. Characterized by fever, pain
back, radicular pain, weakness in the legs, disorders of defecation and urination. Sometimes a patient
complains of weakness or difficulty walking,and objective evidence of defeat yet. The main danger is the destruction of brain tissue due to venous thrombosis or compression of the spinal cord. If time does not detect a spinal epidural abscess, possible irreversible consequences, such as paralysis. In the absence of focal neurological symptoms permissible attempt of conservative treatment with antibiotics, but most require urgent decompression of the spinal cord by laminectomy and drainage of the site of infection. Intracranial epidural abscess develops as a complication of sinusitis, trauma craniotomy. The clinical picture consists of the symptoms of osteomyelitis adjacent bones, intracranial volume processes, cerebral edema, and often - a secondary infection subdural space. For life-saving emergency surgery is necessary.
Finally, Staphylococcus aureus is the most common cause of superficial vein thrombophlebitis
brain and cerebral venous sinus thrombosis - a typical complication of sinusitis,
mastoiditis, facial soft tissue infections. The clinical picture depends on the underlying disease and the anatomical structures, which are in contact with the diseased vein or sinus. Possible impairment of consciousness, paralysis, paresis.
Urinary tract infections caused by staphylococcus
Staphylococcus aureus - uncommon cause of urinary tract infections. Primary
staphylococcal infections almost always occur after cystoscopy, urinary permanent installation
and other catheter procedures. In other cases, the presence of Staphylococcus aureus in the urine, even in small quantities, gives reason to suspect popadenii aureus in blood and kidneys (with or without him abscess). The reason is often a staphylococcal endocarditis.
Endovascular infections caused by staphylococcus
Staphylococcus aureus - the mostcommon causative agent of acute infective endocarditis, including endocarditis, prosthetic valves. Staphylococcal endocarditis is an acute febrile illness lasting no more than a few weeks. By the time of seeking medical care often have time to develop serious complications - meningitis, brain abscess and abdominal septic embolism, peripheral arterial disease, heart failure due to valve insufficiency, myocardial abscess, purulent pericarditis. Most often affects the mitral or aortic valve (or both). An exception is the staphylococcal endocarditis in intravenous drug users, in which often suffers from the tricuspid valve. Typical symptoms of the disease: heart murmur, bleeding in the eye, subungual hemorrhage and hemorrhagic rash on the palms and soles.
Staphylococcal endocarditis is associated with high mortality (40-60%), therefore the antimicrobial
we should start therapy immediately.
Complications requiring valve prosthesis,develop in about half of patients, so as soon as possible should consult a heart surgeon. Delaying surgery worsens the prognosis. Endocarditis right heart is mostly found in injecting drug users and in patients who underwent catheterization of the veins. He is often complicated by septic embolism pulmonary artery branches, but otherwise gives less complications than left endocarditis departments. The prognosis for endocarditis, right heart is better, and the indications for valve replacement are less common than endocarditis left divisions. To cure is enough two-week course of antimicrobial therapy. On the contrary, when staphylococcal endocarditis, prosthetic valves (both early and late) indication to replace them almost always arise.
The tendency of Staphylococcus aureus attached to the damaged tissues makes it a major
the agent and other endovascular infections. They arise when the drift of Staphylococcus aureus
in damaged blood vessels. In particular, colonization of atherosclerotic plaques in major
arteries leading to the development of septic aneurysm. It is also possible direct spread
infection from an adjacent chamber. In this way, there are infected false aneurysm after angioplasty and suppurative thrombophlebitis venous catheterization. Staphylococcal infection affected
artery atherosclerosis (most often it is the abdominal aorta or iliac arteries) with the development of
aneurysm - a severe complication. It is accompanied by the release of a large number of staph in
blood and ends aneurysm rupture with profuse bleeding. Without a excision of the affected
artery bypass portion and almost impossible to cure.
The purulent thrombophlebitis is also accompanied by the release of a large amount of blood and Staphylococcus
intoxication, but the vein ruptures occur much less frequently. Thus it is necessary to remove the infected
thrombus or excised vein. If it is technically difficult, it is justified by the attempt of conservative treatment
antibiotics and antikoagulyantami.V number stafilokoka getting complications include abscesses in the blood
abdomen and brain, meningitis, purulent arthritis, osteomyelitis, infective endocarditis, septic aneurysm.
Stafilokokovye muscle infections, bone and joint
Staphylococcus aureus - the main exciteracute osteomyelitis in adults and one of the most common in children. Acute osteomyelitis is caused by skidding blood staphylococci (especially in the damaged bone) or spread from a contiguous focus of infection. In adults, hematogenous osteomyelitis most often affects the body of the vertebrae in children - long bones. In acute osteomyelitis in adults leading to the clinical picture is a violation of the general condition and pain in the affected area, which does not appear immediately. Acute osteomyelitis usually require antimicrobial therapy within 4-6 weeks.
Chronic osteomyelitis is also often calledStaphylococcus aureus. It develops at the site of surgical wounds, injury, in violation of the blood supply to the bone. Chronic osteomyelitis is very different from most other staph infections, which tend to rapid course. It can remain asymptomatic for years or even decades, and then give a spontaneous recurrence of pain, fistula formation and pus. In chronic osteomyelitis require surgery followed by prolonged antimicrobial therapy.
Its features have osteomyelitis after prosthetic joints, submersible and outdoor
osteosynthesis. prosthetic joint infection causes pain, fever, swelling and
limiting his mobility. One only antibiotics for treatment, is usually not sufficient. In sepsis, persistent bacteremia, clinical or radiographic signs of instability of the prosthesis shown its removal. If the removal of the prosthesis is extremely undesirable, a course / in antimicrobial therapy, followed by the transition to long-term use of drugs inside. Infected ironwork staphylococci, fixing the bone fragments must also be removed, but this procedure often lay on the possible longer term, to give time to grow together fracture.
Staphylococcus aureus - the main causative agent of suppurative arthritis in adults. By disease
predispose injecting drug use,rheumatoid arthritis, treatment with glucocorticoids (systemic or intra-articular injection), penetrating joint injury, osteoarthritis. Most often suffer from knee, hip and sacroiliac joints. In addition to I / antimicrobial therapy requires joint drainage - by repeated punctures, arthroscopic or open surgical procedure. Poor drainage leads to violation of joint mobility. Staphylococcus aureus is also the main causative agent of purulent bursitis.
The called Staphylococcus aureus purulent myositis in temperate climates is rare. One of
species - psoas abscess. Its cause is infection with blood skid or directly
spread on the iliopsoas muscle in spinal osteomyelitis. It manifests
pain in extension legs at the hip joint and fever. Psoas abscess often lends itself
percutaneous drainage, in other cases resort to surgery. Rest
forms of staphylococcal purulent myositisfound almost exclusively in the tropics (the so-called tropical pyomyositis). Almost all cases develop on the background of diabetes, alcoholism, Leukemia or immunosuppressive therapy.