Toxic shock syndrome: Difference between revisions

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* Severe septic shock caused by certain bacterial infections
 
* Severe septic shock caused by certain bacterial infections
   
= Criteria =
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== Criteria ==
   
 
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= Staphylococcal Toxic Shock Syndrome =
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== Staphylococcal Toxic Shock Syndrome ==
   
 
Source: [https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ CDC case definition 2011]
 
Source: [https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ CDC case definition 2011]
   
== Clinical Criteria ==
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=== Clinical Criteria ===
   
 
An illness with the following clinical manifestations:
 
An illness with the following clinical manifestations:
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** '''Central nervous system:''' disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
 
** '''Central nervous system:''' disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
   
== Laboratory Criteria for Diagnosis ==
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=== Laboratory Criteria for Diagnosis ===
   
 
Negative results on the following tests, if obtained:
 
Negative results on the following tests, if obtained:
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* Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles
 
* Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles
   
== Case Classification ==
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=== Case Classification ===
   
 
* 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 =
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== Streptococcal Toxic Shock Syndrome ==
   
 
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 ==
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=== 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*:
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* 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.

Revision as of 15:37, 15 August 2019

  • 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

Streptococcal Toxic Shock Syndrome

Source: 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).