Toxic shock syndrome: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Source==" to "==References== <references/>") |
Neil.m.young (talk | contribs) (Text replacement - "# " to "#") |
||
| Line 19: | Line 19: | ||
==Diagnosis== | ==Diagnosis== | ||
# Fever: temperature >38.9°C | #Fever: temperature >38.9°C | ||
# Rash: diffuse macular erythroderma | #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 | #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: | #Multisystem dysfunction: at least 3: | ||
## Gastrointestinal: vomiting or diarrhea at onset of illness | ##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 | ##Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) greater than twice the upper limit of normal | ||
## Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia | ##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 | ##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) | ||
# Evidence against an alternative diagnosis: If obtained: | #Evidence against an alternative diagnosis: If obtained: | ||
## negative culture results for blood, throat, or cerebrospinal fluid | ##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. | ##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. | ^“Confirmed” case meets all 6 criteria; “probable” case meets 5 of the 6. | ||
Revision as of 14:09, 9 July 2016
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 patients
- nasal packing
- abscess
- burns
- tampons
- IUDs
Diagnosis
- 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.
†Blood culture may be positive for S aureus.
Treatment
- Abx, including Clindamycin, Vanc
- Supportive, pressors often
References
AnnalsofEM Nov 2009