For three days, an infection in the body of the 16-year-olds seems to spread, as long as she is already bad. When she seeks help in the morning at the emergency room, her entire body hurts, she is sick, her head hurts, and she feels she is not getting enough air. Besides, she has felt a knot in the right breast, accidentally.
The 16-year-old is an ambitious competitive swimmer. In the past, she suffered from asthma, otherwise she was healthy, write the physicians around Gregory Taylor of the US Beaumont Hospital in Farmington Hills in the journal "Oxford Medical Case Reports".
In a first examination, the teenager makes a good impression, it does not panic. Even the most important values are in order, from blood pressure to body temperature. While scanning the right breast, the athlete reacts sensitively in one place, but the physicians can not find a knot.
The doctors routinely continue their examinations, X-ray the chest, make an abdominal ultrasound, and send blood to the lab. Everything seems normal. Finally, the 16-year-old gets an infusion to provide her body with fluid and a remedy that relieves muscle pain.
As her condition improves, the doctors dismiss the teenager at noon. She should go to a gynecologist - and come back if she feels worse again.
Same afternoon: rash, as if she had sunburn
That same afternoon, the 16-year-old appears at the gynecologist, her parents accompany her. Within hours, a knot has grown in her chest, which can be felt immediately. Now the adolescent is also ill, she has chills and her temperature is elevated. A rash covers her body, which looks like sunburn and loses its color when pressed. Her face, her neck, her back, her legs, all red.
The heart of the 16-year-old races at 102 beats per minute, her blood pressure has fallen to 92 to 47 mmHg - normal values are up to 100 to 60 mmHg. The gynecologist immediately sends the adolescent to the emergency room.
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The symptoms, especially the rash and the low blood pressure, speak for an extremely dangerous clinical picture: The young woman could suffer from a toxic shock syndrome. The body does not respond directly to pathogens, but to toxins that secrete them. Triggers are mainly bacteria of the species Staphylococcus aureus and Streptococcus pyogenes. The toxic shock syndrome is an emergency. Depending on the type of bacteria, between five and ten percent of those affected die.
Women are almost always affected by the toxic shock syndrome. Tampons that have not been changed for a long time seem to allow bacteria living in the vagina to proliferate and form more toxins. Even contraceptives such as a diaphragm increase the risk. But the 16-year-old had her period last three weeks ago. She has not used tampons since, nor does she use contraceptives.
Is the Knubbel guilty?
In rarer cases the toxic shock syndrome develops independently of the menstruation. Then it is often the result of bacterial infections, such as skin diseases, burns or insect bites.
Is the bump in the right breast related to the symptoms?
From the outside, no inflammation is visible. When you touch the doctors, however, feel a 2.5 cm something in the depth of the chest. When they look at the tissue on ultrasound, several abscesses show up - inflamed, purulent spots that the body has encapsulated. They could be the source of bacterial toxins.
Abscesses in the chest usually arise when pathogens enter the body via the nipple. Often Staphylococcus aureus is the trigger. It is also the bacteria whose poisons trigger the toxic shock syndrome.
The toxic shock syndrome
How common is the toxic shock syndrome?
The toxic shock syndrome is very rare, the Robert Koch Institute expects three to six cases to 100,000 women of sexually active age. Since the industry overturned certain extremely absorbent tampons in the 1980s, the number of those affected has fallen sharply. It also protects you from changing your cotton ball after eight hours at the latest. Since people make antibodies against the bacteria and their toxins in the course of their lives, almost only young people get sick.
How often does it go back to a breast abscess?
In the past, only isolated cases have been described in which the abscesses have led to a toxic shock syndrome. However, the women - in contrast to the 16-year-olds - always had a mastitis, a so-called mastitis.
With which complaints should one go to the doctor?
Those who develop a sudden fever, accompanied by a sunburn-like skin rash and low blood pressure, should have the complaints cleared up by a doctor. Other possible symptoms include nausea, diarrhea, headache or muscle aches.
The doctors give the 16-year-old two different antibiotics, but at first their blood pressure continues to fall. Their organs threaten not to be adequately supplied with blood. The adolescent comes to the intensive care unit, where she receives norepinephrine, a stress hormone that stimulates the circulation.
The doctors remove the abscesses from their breasts the same day. Investigations of the wound fluid later show that actually Staphylococcus aureus bacteria have caused the inflammation.
After the procedure, the 16-year-old quickly recovered. The next day, the doctors can stop the stress hormone, after four days, the teenager is released, they should take another ten days antibiotics. At a follow-up one month later, the 16-year-old is completely recovered and has started swimming again.