title: A new therapeutic strategy for streptococcal toxic shock syndrome: a key target for cytokines.
abstract: We searched for innovative treatments specifically targeted to the cytokines of three critically ill patients with streptococcal toxic shock syndrome (STSS). Direct hemoperfusion with polymyxin B-immobilized fiber improved the hemodynamics in all three patients who had developed shock at presentation. Continuous hemodiafiltration coupled with plasma exchange for simultaneous removal of several mediators of the inflammatory cascade improved outcome in case 2 and lessened the aggressive clinical course and prolonged survival in case 3. The application of these technologies appears to open new and interesting therapeutic options and may lead to improved survival in STSS.
authors.affiliation: Department of Internal Medicine, Takasago Municipal Hospital, Takasago.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Naoya
authors.initials: N
authors.lastname: Igaki
authors.forename: Sinichi
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Matsuda
authors.forename: Aritoshi
authors.initials: A
authors.lastname: Kida
authors.forename: Rintarou
authors.initials: R
authors.lastname: Moriguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Sakai
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Tamada
authors.forename: Munetada
authors.initials: M
authors.lastname: Oimomi
authors.forename: Takeo
authors.initials: T
authors.lastname: Goto
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D016638:Critical Illness; D003646:Debridement / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000379:methods; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011112:Polymyxin B / Q000627:therapeutic use; D012121:Respiration, Artificial; D018570:Risk Assessment; D012494:Sampling Studies; D012772:Shock, Septic / Q000382:microbiology / Q000628:therapy*; D016038:Skin Transplantation; D013290:Streptococcal Infections / Q000175:diagnosis / Q000628:therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D011112:Polymyxin B