Toxic shock syndrome

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Background

Criteria

Criteria Staphylococcal Streptococcal
Confirmed hypotension + fever + rash + desquamating + 3 or more other hypotension + 2 or more other
Hypotension SBP ≤90 mmHg SBP ≤90 mmHg
Fever temp ≥38.9ºC
Skin diffuse macular erythroderma followed by desquamation generalized erythematous macular rash that may desquamate
GI n/v/d at onset
Resp ARDS
MSK myalgia ± CK ≥2x ULN soft-tissue necrosis (e.g. nec.fasc)
Mucosa hyperemia of any mucosa
Nephro Creatinine ≥2x ULN, or
pyuria without UTI
Creatinine ≥177 or ≥2x ULN or ≥2x baseline
Hepatic bili/ALT/AST ≥2x ULN ALT/AST/bili ≥2x ULN or ≥2x baseline
Heme thrombocytopenia <100 thrombocytopenia ≤100, or
DIC (INR/fibrinogen/D-dimer)
CNS altered LOC without focal signs

Management

First-Line Beta-lactam Allergy Notes
Streptococcus pyogenes Penicillin G and clindamycin Macrolide or fluoroquinolone, and clindamycin Macrolide and fluoroquinolone resistance increasing
MLS-resistant Streptococcus pyogenes Penicillin G, and vancomycin or teicoplanin Vancomycin or teicoplanin Macrolide resistance associated with clindamycin resistance
Methicillin-susceptible Staphylococcus aureus Cloxacillin or nafcillin or cefazolin, and clindamycin Clarithromycin and clindamycin
Methicillin-resistant Staphylococcus aureus Clindamycin or linezolid, and vancomycin or teicoplanin
Glycopeptide resistant or intermediate Staphylococcus aureus Linezolid and clindamycin (if susceptible) Incidence increasing. Geographical patterns highly variable

Further Reading