Toxic shock syndrome: Difference between revisions
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==Background== | ==Background== | ||
===Epidemiology=== | ===Epidemiology=== | ||
1-2/100,000 cases/ | 1-2/100,000 cases/year | ||
===Etiology=== | ===Etiology=== | ||
S. aureus strain that produces toxic shock syndrome toxin-1 (superantigen) | *[[S. aureus]] strain that produces toxic shock syndrome toxin-1 (superantigen) | ||
*Superantigens stimulate T-cell proliferation independent of antigen-specific binding --> massive cytokine production | |||
Superantigens stimulate T-cell proliferation independent of antigen-specific binding --> massive cytokine production | *Also effect neutrophil chemotaxis suppression, blockage of reticuloendothelial system | ||
Also effect neutrophil chemotaxis suppression, blockage of reticuloendothelial system | |||
===Risk Factors=== | ===Risk Factors=== | ||
| Line 17: | Line 15: | ||
*tampons | *tampons | ||
*IUDs | *IUDs | ||
==Clinical Features== | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 45: | Line 45: | ||
*Abx, including Clindamycin, Vanc | *Abx, including Clindamycin, Vanc | ||
*Supportive, pressors often | *Supportive, pressors often | ||
==Disposition== | |||
==References== | ==References== | ||
Revision as of 12:50, 30 July 2016
Background
Epidemiology
1-2/100,000 cases/year
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
Clinical Features
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
- 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.
Management
- Abx, including Clindamycin, Vanc
- Supportive, pressors often
Disposition
References
AnnalsofEM Nov 2009