Toxic shock syndrome
From IDWiki
- 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
