Pathogenesis of infectious toxic shock
Pathogenesis is a mechanism for the onset and development of a disease, as well as pathological processes resulting from damage to various body systems, starting with molecular disorders and ending with dystrophic changes in organs.
The pathogenesis of infectious toxic shock at the level of small vessels is characterized by the fact that a large amount of toxins, secreted by saprophytic bacteria as a result of their vital activity, enter the circulatory system. This leads to a sharp release of adrenaline, cytokines and other biologically active substances that cause spasm of postcapillary venules and arterioles. The blood discharged through the opened arteriovenous shunts does not perform its direct function and as a result tissue ischemia and metabolic acidosis occur.
Deterioration of blood microcirculation causes tissue hypoxia, and therefore, with oxygen deficiency, anaerobic metabolism is activated. And although this is not beneficial for the body, but with such a metabolism, hemodynamic conditions improve for a short time, and the metabolism of carbohydrates in the brain and myocardium is optimized. However, in the future, it is microcirculation disorders and, as a result, increasing tissue hypoxia that are the main factors contributing to the progression of toxic shock.
At the level of organ systems, the pathogenesis of infectious toxic shock is manifested by the deposition of blood in the capillaries and the release of its liquid part into the intercellular space. At first, relative, and subsequently absolute hypovolemia (a decrease in the volume of circulating blood) occurs, the venous return of blood to the heart decreases.
A decrease in renal perfusion (pumping fluid into the vessels of the kidneys) leads to an excessive drop in glomerular filtration, the resulting edema causes acute renal failure. Similar processes in the lungs contribute to the development of "shock lung", resulting in acute respiratory failure. Dystrophic changes occur in the liver.
Stages of infectious toxic shock. There are 4 stages of infectious toxic shock: 1. The phase of early reversible shock. It is characterized by a shock index of up to 0.7-1.0, tachycardia, pain in muscles, abdomen, headache, disorders of the central nervous system: anxiety, anxiety, depression. The rate of urination is less than 25 ml / h, arterial hypotension may be absent.
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2. Phase of late reversible shock (pronounced shock)
At this stage, there is a critical drop in blood pressure (below 90 mm Hg), the shock index reaches 1.0-1.4. The patient has a frequent pulse (over 100 beats / min) of weak filling, rapid breathing, lethargy and apathy. Disturbances of blood microcirculation are already determined visually: the skin is wet and cold, acrocyanosis (bluish color of the skin).
3. Phase of stable reversible shock (decompensated shock)
The patient's condition continues to deteriorate sharply, the pressure drops, and the pulse rate increases. The shock index reaches 1.5. The bluish color of the skin and mucous membranes (cyanosis) increases, signs of multiple organ failure appear (in this case, pulmonary, renal and hepatic functional failure): oliguria (decreased urination), shortness of breath, sometimes jaundice.
4. Phase of irreversible shock
The name of this stage of the disease speaks for itself. The shock index exceeds 1.5, general hypothermia occurs (an excessive decrease in body temperature), the patient's skin is of an earthy shade with bluish spots around the joints. Dystrophic changes in the organs are aggravated even more, ending in involuntary defecation and coma. The expansion of the zones of necrosis and plasma generalization indicate the imminent death of the organism.
Toxic shock syndrome is a rapidly progressive disease that poses an immediate threat to human life. If you have characteristic symptoms, then do not self-medicate, but urgently seek medical help. The sooner the therapy starts, the more chances are to exclude possible complications.
Quite often, infectious toxic shock develops with croupous (pneumococcal) pneumonia, infectious diseases, severe influenza, salmonellosis, diphtheria, skin injuries, and the use of tampons during the menstrual cycle.
In the treatment of toxic shock, antibiotics are used that are active against the causative agent of the disease. They are used as long as necessary, which usually depends on the type of streptococcal or staphylococcal infection and the severity of symptoms. With timely treatment and the absence of serious complications, most patients recover within 1-2 weeks.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
