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 |
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* Caused by superantigens, which non-specifically activate T-cells |
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== Criteria == |
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[[Category:Infectious syndromes]] |
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== Staphylococcal Toxic Shock Syndrome == |
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Source: [https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ CDC case definition 2011] |
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=== Clinical Criteria === |
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An illness with the following clinical manifestations: |
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* '''Fever:''' temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C) |
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* '''Rash:''' diffuse macular erythroderma |
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* '''Desquamation:''' 1-2 weeks after onset of rash |
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* '''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 |
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* '''Multisystem involvement''' (three or more of the following organ systems): |
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** '''Gastrointestinal:''' vomiting or diarrhea at onset of illness |
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** '''Muscular:''' severe myalgia or creatine phosphokinase level at least twice the upper limit of normal |
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** '''Mucous membrane:''' vaginal, oropharyngeal, or conjunctival hyperemia |
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** '''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 |
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** '''Hepatic:''' total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory |
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** '''Hematologic:''' platelets less than 100,000/mm3 |
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** '''Central nervous system:''' disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent |
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=== Laboratory Criteria for Diagnosis === |
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Negative results on the following tests, if obtained: |
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* Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus) |
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* Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles |
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=== Case Classification === |
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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 |
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* 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 |
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Revision as of 14:06, 12 September 2019
- Severe septic shock caused by certain bacterial infections
- Caused by superantigens, which non-specifically activate T-cells
| 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 |
