Toxic shock syndrome - Revision history

Aidan at 14:34, 22 November 2022

2022-11-22T14:34:12Z

@@ Line 1: / Line 1: @@
 * Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]''
-** Caused by superantigens, which non-specifically activate T-cells
+** Caused by superantigens, which non-specifically activate a massive number of T-cells
 *Similar syndrome can be caused by toxin production of [[Clostridial toxic shock syndrome|''Clostridium sordelli'']]
 {| class="wikitable"
 ! Criteria
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+|
 |}
 [[Category:Infectious syndromes]]

Aidan at 14:43, 8 April 2022

2022-04-08T14:43:50Z

← Older revision		Revision as of 14:43, 8 April 2022
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	* Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]''		* Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]''
	** Caused by superantigens, which non-specifically activate T-cells		** Caused by superantigens, which non-specifically activate T-cells
	*Similar syndrome can be caused by toxin production of [[Clostridial toxic shock syndrome\|Clostridium sordelli]]		*Similar syndrome can be caused by toxin production of [[Clostridial toxic shock syndrome\|''Clostridium sordelli'']]

	{\| class="wikitable"		{\| class="wikitable"

Aidan at 16:47, 14 December 2021

2021-12-14T16:47:39Z

← Older revision		Revision as of 16:47, 14 December 2021
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	* Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]''		* Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]''
	* Caused by superantigens, which non-specifically activate T-cells		** Caused by superantigens, which non-specifically activate T-cells
			*Similar syndrome can be caused by toxin production of [[Clostridial toxic shock syndrome\|Clostridium sordelli]]

	{\| class="wikitable"		{\| class="wikitable"

Aidan at 13:23, 24 June 2021

2021-06-24T13:23:18Z

← Older revision		Revision as of 13:23, 24 June 2021
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	{\| class="wikitable"		{\| class="wikitable"
	! Criteria		! Criteria
	! Staphylococcal		! [[Staphylococcal toxic shock syndrome\|Staphylococcal]]
	! Streptococcal		! [[Streptococcal toxic shock syndrome\|Streptococcal]]
	\|-		\|-
	\| Confirmed		\| Confirmed

Aidan at 16:41, 1 February 2020

2020-02-01T16:41:48Z

← Older revision		Revision as of 16:41, 1 February 2020
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	* Severe septic shock caused by certain bacterial infections		* Severe septic shock caused by certain bacterial infections, primarily ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pyogenes]]''
	* Caused by superantigens, which non-specifically activate T-cells		* Caused by superantigens, which non-specifically activate T-cells

Aidan: moved staph TSS to own page

2019-09-12T14:06:52Z

moved staph TSS to own page

@@ Line 1: / Line 1: @@
 * Severe septic shock caused by certain bacterial infections
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@@ Line 57: / Line 56: @@
 |}

Aidan: Aidan moved page Toxic shock syndromes to Toxic shock syndrome over redirect

2019-09-12T14:06:09Z

Aidan moved page Toxic shock syndromes to Toxic shock syndrome over redirect

← Older revision		Revision as of 14:06, 12 September 2019
(No difference)

Aidan: /* Streptococcal Toxic Shock Syndrome */ removing to separate pages

2019-09-12T14:04:05Z

Streptococcal Toxic Shock Syndrome: removing to separate pages

← Older revision		Revision as of 14:04, 12 September 2019
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	* Probable: A case which meets the laboratory criteria and in which four of the five clinical criteria described above are present		* Probable: A case which meets the laboratory criteria and in which four of the five clinical criteria described above are present
	* Confirmed: A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs		* Confirmed: A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs

	== Streptococcal Toxic Shock Syndrome ==

	=== Case definition ===

	Source: [https://wwwn.cdc.gov/nndss/conditions/streptococcal-toxic-shock-syndrome/case-definition/2010/ CDC case definition 2010]

	==== Clinical Description ====

	Streptococcal toxic shock syndrome (STSS) is a severe illness associated with invasive or noninvasive group A streptococcal (Streptococcus pyogenes) infection. STSS may occur with infection at any site but most often occurs in association with infection of a cutaneous lesion. Signs of toxicity and a rapidly progressive clinical course are characteristic, and the case fatality rate may exceed 50%.

	==== Clinical Criteria ====

	An illness with the following clinical manifestations*:

	* '''Hypotension''' defined by a systolic blood pressure less than or equal to 90 mm Hg for adults or less than the fifth percentile by age for children aged less than 16 years.
	* '''Multi-organ involvement''' characterized by two or more of the following:
	** '''Renal impairment:''' Creatinine greater than or equal to 2 mg/dL (greater than or equal to 177 µmol/L) for adults or greater than or equal to twice the upper limit of normal for age. In patients with preexisting renal disease, a greater than twofold elevation over the baseline level.
	** '''Coagulopathy:''' Platelets less than or equal to 100,000/mm3 (less than or equal to 100 x 106/L) or disseminated intravascular coagulation, defined by prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products.
	** '''Liver involvement:''' Alanine aminotransferase, aspartate aminotransferase, or total bilirubin levels greater than or equal to twice the upper limit of normal for the patient's age. In patients with preexisting liver disease, a greater than twofold increase over the baseline level.
	** '''Acute respiratory distress syndrome:''' defined by acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure or by evidence of diffuse capillary leak manifested by acute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia.
	** A '''generalized erythematous macular rash''' that may desquamate.
	** '''Soft-tissue necrosis''', including necrotizing fasciitis or myositis, or gangrene.

	* Clinical manifestations do not need to be detected within the first 48 hours of hospitalization or illness, as specified in the 1996 case definition. The specification of the 48 hour time constraint was for purposes of assessing whether the case was considered nosocomial, not whether it was a case or not.

	==== Laboratory Criteria for Diagnosis ====

	* Isolation of group A Streptococcus.

	==== Case Classification ====

	* Probable: A case that meets the clinical case definition in the absence of another identified etiology for the illness and with isolation of group A Streptococcus from a non-sterile site.
	* Confirmed: A case that meets the clinical case definition and with isolation of group A Streptococcus from a normally sterile site (e.g., blood or cerebrospinal fluid or, less commonly, joint, pleural, or pericardial fluid).

	=== Management ===

	* [[Penicillin]] or other antistreptococcal beta-lactam
	* Plus [[clindamycin]] for 72 hours and improving clinically
	** All GAS is susceptible to penicillin, so we need that
	** Erythromycin resistance is still rare, but increasing
	** Clindamycin/erythromycin may be more active in animal models of necrotizing fasciitis and myonecrosis
	** PBPs are not expressed during stationary-phase growth, so penicillin is less helpful when there is a large burden of bacteria (Eagle phenomenon)
	** Clindamycin blocks protein production (exotoxin and M protein)
	** Clindamycin has a longer half-life than penicillin
	** The two antibiotics are ''not'' antagonistic in vitro, so combination shouldn't cause problems
	** Clindamycin and azithromycin suppress cytokine production
	* And maybe with [[IVIg]]

	[[Category:Infectious syndromes]]

Aidan: /* Management */

2019-09-12T14:03:51Z

Management

← Older revision		Revision as of 14:03, 12 September 2019
Line 127:		Line 127:

	* [[Penicillin]] or other antistreptococcal beta-lactam		* [[Penicillin]] or other antistreptococcal beta-lactam
	* Plus [[clindamycin]]		* Plus [[clindamycin]] for 72 hours and improving clinically
	** All GAS is susceptible to penicillin, so we need that		** All GAS is susceptible to penicillin, so we need that
	** Erythromycin resistance is still rare, but increasing		** Erythromycin resistance is still rare, but increasing

Aidan: /* Streptococcal Toxic Shock Syndrome */ added 8 reasons for combo pcn/clinda

2019-09-12T13:57:16Z

Streptococcal Toxic Shock Syndrome: added 8 reasons for combo pcn/clinda

← Older revision		Revision as of 13:57, 12 September 2019
Line 91:		Line 91:

	== Streptococcal Toxic Shock Syndrome ==		== Streptococcal Toxic Shock Syndrome ==

			=== Case definition ===

	Source: [https://wwwn.cdc.gov/nndss/conditions/streptococcal-toxic-shock-syndrome/case-definition/2010/ CDC case definition 2010]		Source: [https://wwwn.cdc.gov/nndss/conditions/streptococcal-toxic-shock-syndrome/case-definition/2010/ CDC case definition 2010]

	=== Clinical Description ===		==== Clinical Description ====

	Streptococcal toxic shock syndrome (STSS) is a severe illness associated with invasive or noninvasive group A streptococcal (Streptococcus pyogenes) infection. STSS may occur with infection at any site but most often occurs in association with infection of a cutaneous lesion. Signs of toxicity and a rapidly progressive clinical course are characteristic, and the case fatality rate may exceed 50%.		Streptococcal toxic shock syndrome (STSS) is a severe illness associated with invasive or noninvasive group A streptococcal (Streptococcus pyogenes) infection. STSS may occur with infection at any site but most often occurs in association with infection of a cutaneous lesion. Signs of toxicity and a rapidly progressive clinical course are characteristic, and the case fatality rate may exceed 50%.

	=== Clinical Criteria ===		==== Clinical Criteria ====

	An illness with the following clinical manifestations*:		An illness with the following clinical manifestations*:
Line 113:		Line 115:
	* Clinical manifestations do not need to be detected within the first 48 hours of hospitalization or illness, as specified in the 1996 case definition. The specification of the 48 hour time constraint was for purposes of assessing whether the case was considered nosocomial, not whether it was a case or not.		* Clinical manifestations do not need to be detected within the first 48 hours of hospitalization or illness, as specified in the 1996 case definition. The specification of the 48 hour time constraint was for purposes of assessing whether the case was considered nosocomial, not whether it was a case or not.

	=== Laboratory Criteria for Diagnosis ===		==== Laboratory Criteria for Diagnosis ====

	* Isolation of group A Streptococcus.		* Isolation of group A Streptococcus.

	=== Case Classification ===		==== Case Classification ====

	* Probable: A case that meets the clinical case definition in the absence of another identified etiology for the illness and with isolation of group A Streptococcus from a non-sterile site.		* Probable: A case that meets the clinical case definition in the absence of another identified etiology for the illness and with isolation of group A Streptococcus from a non-sterile site.
	* Confirmed: A case that meets the clinical case definition and with isolation of group A Streptococcus from a normally sterile site (e.g., blood or cerebrospinal fluid or, less commonly, joint, pleural, or pericardial fluid).		* Confirmed: A case that meets the clinical case definition and with isolation of group A Streptococcus from a normally sterile site (e.g., blood or cerebrospinal fluid or, less commonly, joint, pleural, or pericardial fluid).

			=== Management ===

			* [[Penicillin]] or other antistreptococcal beta-lactam
			* Plus [[clindamycin]]
			** All GAS is susceptible to penicillin, so we need that
			** Erythromycin resistance is still rare, but increasing
			** Clindamycin/erythromycin may be more active in animal models of necrotizing fasciitis and myonecrosis
			** PBPs are not expressed during stationary-phase growth, so penicillin is less helpful when there is a large burden of bacteria (Eagle phenomenon)
			** Clindamycin blocks protein production (exotoxin and M protein)
			** Clindamycin has a longer half-life than penicillin
			** The two antibiotics are ''not'' antagonistic in vitro, so combination shouldn't cause problems
			** Clindamycin and azithromycin suppress cytokine production
			* And maybe with [[IVIg]]

	[[Category:Infectious syndromes]]		[[Category:Infectious syndromes]]