Toxic shock syndrome: Difference between revisions

Revision as of 05:37, 28 March 2011

Background

Epidemiology

1-2/100,000 cases/yr

Etiology

S. aureus strain that produces toxic shock syndrome toxin-1 (superantigen)

Superantigens stimulate T-cell proliferation independent of antigen-specific binding --> massive cytokine production

Also effect neutrophil chemotaxis suppression, blockage of reticuloendothelial system

Risk Factors

postop pts
nasal packing
abscess
burns
tampons
IUDs

Definition

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:
1. Gastrointestinal: vomiting or diarrhea at onset of illness
2. Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) greater than twice the upper limit of normal
3. Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
4. 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
5. Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal
6. Hematologic: platelets<100,000/L
7. 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)
Evidence against an alternative diagnosis: If obtained:
1. negative culture results for blood, throat, or cerebrospinal fluid
2. absence of an increase in antibody titers to the agents of leptospirosis, measles, or Rocky Mountain spotted fever.

^“Confirmed” case meets all 6 criteria; “probable” case meets 5 of the 6.

†Blood culture may be positive for S aureus.

Treatment

Abx, including Clindamycin, Vanc
Supportive, pressors often

Source

AnnalsofEM Nov 2009

Authors:

@@ Line 1: / Line 1: @@
-==Epidemiology==
+==Background==
+===Epidemiology===
 -2/100,000 cases/yr
+===Etiology===
-==Etiology==
 S. aureus strain that produces toxic shock syndrome toxin-1 (superantigen)
@@ Line 15: / Line 10: @@
 Also effect neutrophil chemotaxis suppression, blockage of reticuloendothelial system
+==Risk Factors==
+#postop pts
-==RF==
+#nasal packing
+#abscess
+#burns
-postop pts, nasal packing, abscess, burns, tampons...IUDs!
+#tampons
+#IUDs
-== ==
 ==Definition==
+# 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)
+# Evidence against an alternative diagnosis: If obtained:
+## negative culture results for blood, throat, or cerebrospinal fluid
+## absence of an increase in antibody titers to the agents of leptospirosis, measles, or Rocky Mountain spotted fever.
+^“Confirmed” case meets all 6 criteria; “probable” case meets 5 of the 6.
-I. Fever: temperature >38.9°C
-II. Rash: diffuse macular erythroderma
-III. Hypotension: systolic blood pressure <90 mm Hg (adults) or <5th percentile for age (children younger than 16 years), or orthostatic hypotension, dizziness, or syncope
-IV. Multisystem dysfunction: at least 3:
-     A. Gastrointestinal: vomiting or diarrhea at onset of illness
-     B. Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) greater than twice the upper limit of normal
-     C. Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
-     D. 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
-     E. Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal
-     F. Hematologic: platelets<100,000/L
-     G. Central nervous system: disorientation or alteration in consciousness but no focal neurologic signs at a time when fever and hypotension are absent.
-V. Desquamation: One to 2 weeks after the onset of illness (typically palms and soles)
-VI. Evidence against an alternative diagnosis: If obtained:
-. negative culture results for blood, throat, or cerebrospinal fluid
-. absence of an increase in antibody titers to the agents of leptospirosis, measles, or Rocky Mountain spotted fever.
-*“Confirmed” case meets all 6 criteria; “probable” case meets 5 of the 6.
 †Blood culture may be positive for S aureus.
 ==Treatment==
+#Abx, including Clindamycin, Vanc
+#Supportive, pressors often
-Abx, including Clindamycin, Vanc
-Supportive, pressors often
 ==Source==
 AnnalsofEM Nov 2009
 [[Category:ID]]