Decreased number of capillary loops in nail folds

Introduction The reduction in the number of capillary folds is caused by septic shock! Severe infections, especially Gram-negative bacterial infections, often cause septic shock. Septic shock, also known as septic shock, refers to sepsis syndrome caused by products such as microorganisms and their toxins.

Cause

(1) Pathogens: Common pathogens of septic shock are Gram-negative bacteria, such as Enterobacteriaceae (Escherichia coli, Klebsiella, Enterobacter, etc.), non-fermenting bacilli (Pseudomonas, no Bacillus, etc.), meningococcal, bacillus, etc. Gram-positive bacteria, such as grape balls, streptococcus, Streptococcus pneumoniae, Clostridium, etc. can also cause shock. Certain viral diseases, such as epidemic hemorrhagic fever, are also prone to shock during the course of the disease. Some infections, such as Gram-negative bacterial sepsis, fulminant meningitis, pneumonia, suppurative cholangitis, abdominal infections, bacillary dysentery (children) are complicated by shock.

(B), host factors: the original chronic basic diseases, such as cirrhosis, diabetes, malignant tumors, leukemia, burns, organ transplantation and long-term acceptance of immunosuppressive drugs such as adrenal cortex hormones, antimetabolites, bacterial drugs and radiation therapy , or the application of an indwelling catheter or venous catheter can induce septic shock. Therefore, the disease is more common in patients infected with the hospital, the elderly, infants, women who give birth, and poor physical recovery after major surgery are particularly prone to occur.

(C), a special type of septic shock toxic shock syndrome (TSS) TSS is a serious syndrome caused by bacterial toxins. The TSS originally reported was caused by Staphylococcus aureus, and in recent years it has been found that similar colonies can also be caused by streptococcus.

1. Staphylococcus aureus TSS is caused by exotoxins produced by non-invasive Staphylococcus aureus. The first report was published in 1978. In the early years, menopausal women who used vaginal plugs were found to have obvious regional distribution, mainly in the United States, followed by Canada, Australia and some European countries. With the improvement of vaginal plug, the incidence of S. aureus TSS has been significantly reduced after the use of high-absorbency vaginal plug, but the TSS is increased in non-menstrual period. The lesions are mostly infected by skin and subcutaneous tissues and wounds, followed by upper respiratory tract infection. Etc., no gender, ethnicity and regional characteristics. Almost all cases seen in China are non-menstrual TSS. Staphylococcus aureus can be isolated from the patient's vagina and cervical local lesions, but blood culture is negative. Isolation of pyrogenic exotoxin C (PEC) and enterotoxin F (SEF) from this non-invasive Staphylococcus aureus, collectively known as toxic shock syndrome toxin 1 (TSST-1), is thought to be associated with the pathogenesis of TSS .

Injecting animals with purified TSST-1 can cause symptoms that mimic human TSS. The main clinical manifestations of TSS are acute high fever, headache, confusion, scarlet fever rash, skin desquamation after 1 to 2 weeks (especially on the soles of the feet), severe hypotension or orthostatic syncope. Often multiple system involvement, including: gastrointestinal (vomiting, diarrhea, diffuse abdominal pain), muscle (myalgia, increased blood CPK), mucosa (conjunctiva, pharynx, vagina) congestion, central nervous system (headache, dizziness, Orientation, mental changes, etc.; liver (jaundice, ALT and AST values, etc.), kidney (oliguric or no urine, proteinuria, blood urea nitrogen and creatinine, etc.); heart (can appear heart failure, myocarditis, Pericarditis and atrioventricular block, etc., blood (platelet reduction, etc.). Menstrual TSS patients often have vaginal discharge, cervical congestion, erosion, attachments may have tenderness. About 3% relapsed.

2. Streptococcus TSS (STSS), also known as Streptococcus TSS-like syndrome (TSLS). Since 1983, Group A streptococci-induced toxic shock syndrome (STSS) has been reported in North America and Europe. The main pathogenic substance is pyrogenic exotoxin A (SPEA). SPEA as a superantigen (SAg) stimulates monocytes to produce tumor necrosis factor (TNF-) interleukin (IL-1) and directly inhibits myocardium. Causes capillary leakage and causes shock. Domestically, in some areas of the Yangtze River Delta in the autumn of 1990 to the spring of 1991 (Haian, Wuxi, etc.), the outbreak of scarlet fever-like diseases was found to be rare in recent decades. Rapid onset, chills, fever, headache, sore throat (40%), pharyngeal congestion, vomiting (60%), diarrhea (30%). On the second day of fever, a scarlet fever-like rash appeared, and the period of recovery was desquamation and peeling. Symptoms of systemic poisoning are severe, nearly half have different degrees of hypotension, and even coma. A few have multiple organ dysfunction. The virulence of streptococcus mitis is isolated from the throat swab culture of most patients. In the case of individual cases, the same pathogen was detected in the blood, but the type B hemolytic streptococcus was not isolated. The corresponding antibodies were detected from the serum of the recovery period patients.

Injecting the isolated strain into the skin of rabbits or guinea pigs can cause local swelling and suppurative damage with elevated body temperature. After timely antibacterial treatment (using penicillin, erythromycin or clindamycin, etc.) and antibody shock, most patients recover.

an examination

Related inspection

Bacteriological test

In shock, it can be seen that the number of capillary folds of the nail fold is reduced, the diameter of the tube is thin and shortened, the line is broken, the filling is poor, the blood color becomes purple, the blood flow is slow and the uniformity is lost, and in severe cases, blood coagulation occurs.

Differential diagnosis

Capillary Leakage Syndrome: Capillary leak syndrome is a sudden, reversible capillary permeability that rapidly penetrates blood vessels from the blood vessels into the interstitial space. Rapid onset of progressive systemic edema, hypoproteinemia, decreased blood pressure and central venous pressure, weight gain, blood concentration, and multiple organ failure can occur in severe cases.

Highly inflated capillary vasospasm: a pathologically characteristic morphological change - an enlarged glomerular volume, a highly bloated capillary vasospasm, a kidney disease patient with a layered altered "embolic", should pay attention to whether Lipoprotein glomerulopathy (lipoprotein glomerulopathy) is a kidney disease characterized by the presence of lipoprotein emboli in the glomerular capillaries and extrarenal lipoprotein embolism. Lipoprotein glomerulopathy is more common in men, with a male to female ratio of 15:8. The average age of onset is 32 years (4 to 49 years old). Most cases are sporadic and a few are familial.

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