Toxic shock syndrome: Difference between revisions
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*IUDs | *IUDs | ||
==Clinical Features<ref name="CDC">CDC. Toxic Shock Syndrome (Other Than Streptococcal). 2011</ref>== | ==Clinical Features/Criteria<ref name="CDC">CDC. Toxic Shock Syndrome (Other Than Streptococcal). 2011</ref>== | ||
*[[Fever]]: temperature >38.9°C | *[[Fever]]: temperature >38.9°C | ||
*[[Rash]]: diffuse macular erythroderma | *[[Rash]]: diffuse macular erythroderma | ||
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**Renal: blood urea nitrogen or creatinine level greater than twice the upper limit of normal, or pyuria (5 leukocytes per high-power field), in the absence of urinary tract infection | **Renal: blood urea nitrogen or creatinine level greater than twice the upper limit of normal, or pyuria (5 leukocytes per high-power field), in the absence of urinary tract infection | ||
**Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal | **Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal | ||
**Hematologic: platelets<100,000/L | **Hematologic: platelets <100,000/L | ||
**Central nervous system: disorientation or alteration in consciousness but no focal neurologic signs at a time when fever and hypotension are absent. | **Central nervous system: disorientation or alteration in consciousness but no focal neurologic signs at a time when fever and hypotension are absent. | ||
*Desquamation: One to 2 weeks after the onset of illness (typically palms and soles) | *Desquamation: One to 2 weeks after the onset of illness (typically palms and soles) | ||
Revision as of 22:39, 29 November 2017
Background
- 1-2/100,000 cases/year
- S. aureus strain that produces toxic shock syndrome toxin-1 (superantigen) is the most common cause
- GAS is a less common cause
- Superantigens stimulate T-cell proliferation independent of antigen-specific binding → massive cytokine production
- Also affect neutrophil chemotaxis suppression and blockage of reticuloendothelial system
Risk Factors
- Postop patients
- nasal packing
- Abscess
- Burns
- Tampon use
- IUDs
Clinical Features/Criteria[1]
- Fever: temperature >38.9°C
- Rash: diffuse macular erythroderma
- Hypotension: systolic blood pressure <90 mm Hg (adults) or <5th percentile for age (children younger than 16 years), or orthostatic hypotension, dizziness, or syncope
- Multisystem dysfunction: at least 3:
- Gastrointestinal: vomiting or diarrhea at onset of illness
- Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) greater than twice the upper limit of normal
- Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
- Renal: blood urea nitrogen or creatinine level greater than twice the upper limit of normal, or pyuria (5 leukocytes per high-power field), in the absence of urinary tract infection
- Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal
- Hematologic: platelets <100,000/L
- Central nervous system: disorientation or alteration in consciousness but no focal neurologic signs at a time when fever and hypotension are absent.
- Desquamation: One to 2 weeks after the onset of illness (typically palms and soles)
Differential Diagnosis
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
- Lab Criteria for Diagnosis (if obtained)[1]:
- Negative culture results for blood, or cerebrospinal fluid (blood may be positive for S. aureus)
- Absence of an increase in antibody titers to the agents of leptospirosis, measles, or Rocky mountain spotted fever.
- Confirmed case meets all 5 clinical criteria (clinical features) plus lab criteria
- Probable case meets 4-5 clinical criteria plus lab criteria
Management
- Antibiotics: Clindamycin (suppresses toxin synthesis), plus an anti-staph penicillin (e.g. Oxacillin or Nafcillin) or Vancomycin
- Supportive, pressors often
Disposition
- Admit