Toxic shock syndrome: Difference between revisions
From IDWiki
mNo edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
== Background == |
|||
* 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 a massive number of 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'']] |
||
== Criteria == |
|||
{| class="wikitable" |
{| class="wikitable" |
||
! Criteria |
! Criteria |
||
| Line 56: | Line 58: | ||
| |
| |
||
|} |
|} |
||
== Management == |
|||
{| class="wikitable" |
|||
! |
|||
!First-Line |
|||
!Beta-lactam Allergy |
|||
!Notes |
|||
|- |
|||
|[[Streptococcus pyogenes]] |
|||
|[[Penicillin G]] and [[clindamycin]] |
|||
|[[Macrolide]] or [[fluoroquinolone]], and [[clindamycin]] |
|||
|Macrolide and fluoroquinolone resistance increasing |
|||
|- |
|||
|MLS-resistant [[Streptococcus pyogenes]] |
|||
|[[Penicillin G]], and [[vancomycin]] or [[teicoplanin]] |
|||
|[[Vancomycin]] or [[teicoplanin]] |
|||
|Macrolide resistance associated with clindamycin resistance |
|||
|- |
|||
|Methicillin-susceptible [[Staphylococcus aureus]] |
|||
|[[Cloxacillin]] or [[nafcillin]] or [[cefazolin]], and [[clindamycin]] |
|||
|[[Clarithromycin]] and [[clindamycin]] |
|||
| |
|||
|- |
|||
|Methicillin-resistant [[Staphylococcus aureus]] |
|||
|[[Clindamycin]] or [[linezolid]], and [[vancomycin]] or [[teicoplanin]] |
|||
| |
|||
| |
|||
|- |
|||
|Glycopeptide resistant or intermediate [[Staphylococcus aureus]] |
|||
|[[Linezolid]] and [[clindamycin]] (if susceptible) |
|||
| |
|||
|Incidence increasing. Geographical patterns highly variable |
|||
|} |
|||
== Further Reading == |
|||
* Gram-positive toxic shock syndromes. ''Lancet Infect Dis''. 2009;9(5):281-290. doi: [https://doi.org/10.1016/S1473-3099(09)70066-0 10.1016/S1473-3099(09)70066-0] |
|||
[[Category:Infectious syndromes]] |
[[Category:Infectious syndromes]] |
||
Latest revision as of 14:34, 22 November 2022
Background
- Severe septic shock caused by certain bacterial infections, primarily Staphylococcus aureus and Streptococcus pyogenes
- Caused by superantigens, which non-specifically activate a massive number of T-cells
- Similar syndrome can be caused by toxin production of Clostridium sordelli
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 |
Management
| First-Line | Beta-lactam Allergy | Notes | |
|---|---|---|---|
| Streptococcus pyogenes | Penicillin G and clindamycin | Macrolide or fluoroquinolone, and clindamycin | Macrolide and fluoroquinolone resistance increasing |
| MLS-resistant Streptococcus pyogenes | Penicillin G, and vancomycin or teicoplanin | Vancomycin or teicoplanin | Macrolide resistance associated with clindamycin resistance |
| Methicillin-susceptible Staphylococcus aureus | Cloxacillin or nafcillin or cefazolin, and clindamycin | Clarithromycin and clindamycin | |
| Methicillin-resistant Staphylococcus aureus | Clindamycin or linezolid, and vancomycin or teicoplanin | ||
| Glycopeptide resistant or intermediate Staphylococcus aureus | Linezolid and clindamycin (if susceptible) | Incidence increasing. Geographical patterns highly variable |
Further Reading
- Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009;9(5):281-290. doi: 10.1016/S1473-3099(09)70066-0
