Toxic shock syndrome

• Severe septic shock caused by certain bacterial infections, primarily Staphylococcus aureus and Streptococcus pyogenes
• 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