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You are here: Home / 09. Medical/Surgical / infectious disease / Toxic Shock Syndrome

Toxic Shock Syndrome

July 13, 2012 by CrashMaster

Toxic Shock Syndrome (TSS)

Toxic shock syndrome presents with high fever, rash and hypotension.  Prodrome of malaise, low grade fever, myalgias and vomiting.  Sx may occur 2-3 days after tampon use, soft tissue infection, or within a week of other inciting factors.

Rash is a diffuse, non-pruritic, blanching, macular erythroderma leading to desquamation.

Clinical Criteria for Toxic Shock Syndrome

Hypotension

Fever >102

Rash

·        Erythroderma followed by desquamation

·        Mucous membrane involvement

BP < 90 mmHg

Three or more of the following clinical signs:

1.      CNS-altered mental status without focal deficit

2.     Cardiovascular

a.     Distributive shock

b.     Arrhythmia

c.      Heart failure

d.     AV block

3.     Pulmonary

a.     ARDS

b.     Pulmonary Edema

4.     Gastrointestinal

a.     Vomiting

b.     Diarrhea

5.     Liver involvement

a.     SGPT > 2 ´ normal

b.     Total billirubin > 2 ´ normal

c.      Liver enzymes twice normal for age

d.     Twofold elevation of liver enzymes

6.     Renal impairment

a.     Creatinine greater than  > 2 mg/dL

b.     Creatinine greater than twice upper limit of normal for age

c.      Twofold elevation over the baseline level

7.     Hematologic

a.     Anemia

b.     Coagulopathy-Platelets less than 100,000/mm3

c.      Disseminated intravascular coagulopathy

8.     Metabolic

a.     Hypocalcemia

b.     hypophosphatemia

Pts will have pain out of proportion to physical findings (85%)

Often coexistent with necrotizing fasciitis

Staph Toxic Shock Syndrome

Staph Aureus that produces TSST-1 a pyogenic exotoxin

Rx remove source of infection, toxin mediated (Staph).

Strep Toxic Shock Syndrome

Isolation of group A Streptococcus taht produces extoxin SPE (Strep pyogenic exotoxins):

higher mortality than staph

Treatment for Toxic Shock Syndrome

Aggressive fluid resuscitation

ABX may help in Staph TSS, use Nafcillin, Vancomycin, or Clindamycin

Even more important in Strep TSS, use Pen G or Ampicillin plus clindamycin  and possibly aminoglycoside.  Culture and debride all infected tissue.

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Filed Under: infectious disease


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