Toxic shock syndromes Flashcards
What is the presentation of staphylococcal TSS?
S/s often develop rapidly (< 48 hours), otherwise healthy individuals.
Fever: T ≥ 38.9
Rash: diffuse macular erythroderma (can resemble sunburn)
Desquamation: 1-2 weeks after onset of rash
Hypotension: SBP ≤ 90
Multisystem involvement (3 or more of following):
- GI: vomiting, diarrhoea at onset of illness
- Muscular: Severe myalgia or creatine phosphokinase elevation > 2x ULN
- Mucous membranes: Vaginal, oropharyngeal, or conjunctival hyperaemia (e.g. strawberry tongue)
- Renal: BUN or serum creatinine > 2x ULN, or pyuria (>5 leukocytes/HPF) in the absence of UTI
- Hepatic: Bilirubin or transaminases > 2x ULN
- Haematologic: Platelets < 100
- CNS: Disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
What is the presentation of streptococcal TSS?
Invasive GAS infection (isolation of GAS from a normally sterile body site)
- Pain at site of trauma (most common)
- Discomfort often precedes O/E findings
Early onset (within hours): shock, hypotension, tachycardia, organ failure
Renal failure occurs in nearly all patients within 48-72 hours
Often accompanied by desquamating rash, and has a worse prognosis compared with Staphylococcus TSS
What are the risk factors for staphylococcal toxic shock syndrome?
- recent tampon use, recent surgery,
- recent infection (involving skin or soft tissue or other site, e.g. burns, ulcerations),
- post-op interventions (e.g. nasal packing, catheters)
how is staphylococcal toxic shock syndrome managed?
Manage shock first
(if indicated) KIV wound exploration surgical debridement, in cases of recent sx
Antibiotics (UpToDate recommendation)
- Anti-Staphylococcal abx: cloxacillin (MSSA), vancomycin (MRSA) AND
- Clindamycin (to suppress protein production, given the importance of toxin production in the pathogenesis of staphylococcal TSS)
