Toxic Shock Syndrome
Toxic shock syndrome (TSS)
An acute and potentially severe illness characterized by fever, hypotension, and erythematous rash with subsequent desquamation on the hands and feet, and multisystem involvement, including vomiting, diarrhea, myalgias, nonfocal neurologic abnormalities, conjunctival hyperemia, and strawberry tongue.
Cause:
TSS is caused by TSST-1 producing and some enterotoxin-producing strains of Staphylococcus aureus.
Highest rates in menstruating women 15-25 yr of age who use tampons. The Nonmenstrual TSS is associated with S. aureus infected
- nasal packing and wounds
- sinusitis
- tracheitis
- pneumonia
- empyema
- abscesses
- burns
- osteomyelitis
- primary bacteremia.
Diagnostic Criteria of Staphylococcal Toxic Shock Syndrome:
MAJOR CRITERIA (ALL REQUIRED)
- Acute fever; temperature >38.8°C (101.8°F)
- Hypotension
- Rash - erythroderma with convalescent desquamation
MINOR CRITERIA (ANY 3 OR MORE)
- Mucous membrane inflammation (vaginal, oropharyngeal, or conjunctival hyperemia, strawberry tongue)
- Vomiting, diarrhea
- Liver abnormalities - bilirubin or transaminase greater than twice the upper limit of normal
- Renal abnormalities - blood urea nitrogen or creatinine greater than twice the upper limit of normal, or white blood cells >5 per high-power field
- Muscle abnormalities - myalgia or creatinine phosphokinase greater than twice the upper limit of normal
- Central nervous system abnormalities - alteration in consciousness without focal neurologic signs.
- Thrombocytopenia - ≤100,000/mm3
EXCLUSIONARY CRITERIA
- Absence of another explanation
- Negative blood cultures (except occasionally for Staphylococcus aureus )
