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.
Back to top