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
  +
* Caused by superantigens, which non-specifically activate T-cells
 
== Criteria ==
 
   
 
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[[Category:Infectious syndromes]]
== Staphylococcal Toxic Shock Syndrome ==
 
 
Source: [https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ 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
 

Revision as of 10:06, 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