Toxic shock syndrome: Difference between revisions
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+ | == Background == |
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* 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]]'' |
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− | ** 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 == |
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{| class="wikitable" |
{| class="wikitable" |
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! Criteria |
! Criteria |
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+ | == Management == |
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+ | {| class="wikitable" |
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+ | ! |
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+ | !First-Line |
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+ | !Beta-lactam Allergy |
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+ | !Notes |
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+ | |- |
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+ | |[[Streptococcus pyogenes]] |
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+ | |[[Penicillin G]] and [[clindamycin]] |
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+ | |[[Macrolide]] or [[fluoroquinolone]], and [[clindamycin]] |
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+ | |Macrolide and fluoroquinolone resistance increasing |
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+ | |- |
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+ | |MLS-resistant [[Streptococcus pyogenes]] |
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+ | |[[Penicillin G]], and [[vancomycin]] or [[teicoplanin]] |
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+ | |[[Vancomycin]] or [[teicoplanin]] |
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+ | |Macrolide resistance associated with clindamycin resistance |
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+ | |- |
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+ | |Methicillin-susceptible [[Staphylococcus aureus]] |
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+ | |[[Cloxacillin]] or [[nafcillin]] or [[cefazolin]], and [[clindamycin]] |
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+ | |[[Clarithromycin]] and [[clindamycin]] |
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+ | | |
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+ | |- |
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+ | |Methicillin-resistant [[Staphylococcus aureus]] |
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+ | |[[Clindamycin]] or [[linezolid]], and [[vancomycin]] or [[teicoplanin]] |
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+ | | |
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+ | | |
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+ | |- |
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+ | |Glycopeptide resistant or intermediate [[Staphylococcus aureus]] |
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+ | |[[Linezolid]] and [[clindamycin]] (if susceptible) |
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+ | | |
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+ | |Incidence increasing. Geographical patterns highly variable |
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+ | |} |
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+ | |||
+ | == Further Reading == |
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+ | |||
+ | * 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] |
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[[Category:Infectious syndromes]] |
[[Category:Infectious syndromes]] |
Latest revision as of 10:34, 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