Toxic shock syndrome: Difference between revisions

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  • Severe septic shock caused by certain bacterial infections

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

Staphylococcal Toxic Shock Syndrome

Source: CDC case definition 2011

Clinical Criteria

An illness with the following clinical manifestations:

  • Fever: temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C)
  • Rash: diffuse macular erythroderma
  • Desquamation: 1-2 weeks after onset of rash
  • Hypotension: systolic blood pressure less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years
  • Multisystem involvement (three or more of the following organ systems):
    • Gastrointestinal: vomiting or diarrhea at onset of illness
    • Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal
    • Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia
    • Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection
    • Hepatic: total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory
    • Hematologic: platelets less than 100,000/mm3
    • Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent

Laboratory Criteria for Diagnosis

Negative results on the following tests, if obtained:

  • Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
  • Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles

Case Classification

  • 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