Toxic shock syndrome: Difference between revisions

Revision as of 12:51, 30 July 2016

1-2/100,000 cases/year

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

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.

AnnalsofEM Nov 2009

Authors:

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 ==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