Toxic shock syndrome: Difference between revisions

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==Management==
==Management==
*antibiotic, including [[Clindamycin]], [[Vanc]]
*Antibiotics: [[Clindamycin]] (suppresses toxin synthesis), plus an anti-staph penicillin (Oxacillin or Nafcillin) or [[Vanc]]
*Supportive, [[pressors]] often
*Supportive, [[pressors]] often



Revision as of 16:41, 7 February 2017

Background

Epidemiology

1-2/100,000 cases/year

Etiology

  • S. aureus strain that produces toxic shock syndrome toxin-1 (superantigen)
    • GAS is a less common cause
  • Superantigens stimulate T-cell proliferation independent of antigen-specific binding --> massive cytokine production
  • Also effect neutrophil chemotaxis suppression, blockage of reticuloendothelial system

Risk Factors

Clinical Features

[1]

  • Fever: temperature >38.9°C
  • Rash: diffuse macular erythroderma
  • Hypotension: systolic blood pressure <90 mm Hg (adults) or <5th percentile for age (children younger than 16 years), or orthostatic hypotension, dizziness, or syncope
  • Multisystem dysfunction: at least 3:
    • Gastrointestinal: vomiting or diarrhea at onset of illness
    • Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) greater than twice the upper limit of normal
    • Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
    • Renal: blood urea nitrogen or creatinine level greater than twice the upper limit of normal, or pyuria (5 leukocytes per high-power field), in the absence of urinary tract infection
    • Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal
    • Hematologic: platelets<100,000/L
    • Central nervous system: disorientation or alteration in consciousness but no focal neurologic signs at a time when fever and hypotension are absent.
  • Desquamation: One to 2 weeks after the onset of illness (typically palms and soles)

Differential Diagnosis

Erythematous rash

Evaluation

  • Lab Criteria for Diagnosis (if obtained)[1]:
  • Confirmed case meets all 5 clinical criteria ( Clinical Features ) plus lab criteria
  • Probable case meets 4-5 clinical criteria plus lab criteria

Management

  • Antibiotics: Clindamycin (suppresses toxin synthesis), plus an anti-staph penicillin (Oxacillin or Nafcillin) or Vanc
  • Supportive, pressors often

Disposition

  • Admit

References

  1. 1.0 1.1 CDC. Toxic Shock Syndrome (Other Than Streptococcal). 2011

AnnalsofEM Nov 2009