Pathogenesis
- Staph or strep endotoxin leading to a massive immune response and end-organ damage
Risk Factors
- Tampon use ( mainly staph)
- Post-operative wound infections
- Soft tissue infections
- Sinusitis
Clinical Manifestations
CDC Criteria
- Fever of 102.0°F
- Hypotension ≤90 mmHg for adults or less than 5th percentile by age for children <16 years of age
- Diffuse macular erythroderma
- Desquamation of skin 1 to 2 weeks after onset of rash (especially palms and soles)
- Negative blood cultures for an alternative pathogen
- Multisystem involvement ( 3 or more of the following organ systems)
| Gastrointestinal: Vomiting or diarrhea at onset of illness |
| Muscular: Severe myalgia or creatine phosphokinase elevation >2 times the upper limit of normal |
| Mucous membranes: Vaginal, oropharyngeal, or conjunctival hyperemia |
| Renal: Blood urea nitrogen or serum creatinine >2 times the upper limit of normal or pyuria (>5 white blood count/high power field) in the absence of urinary tract infection |
| Hepatic: Bilirubin or transaminases >2 times the upper limit of normal |
| Hematologic: Platelets <100,000/microL |
| Central nervous system: Disorientation or alterations in consciousness without focal neurologic signs in the absence of fever and hypotension |
Note: Toxic shock should be suspected in patients with rash, fever, and hypotension even if some diagnostic criteria are not met.
Erythroderma Rash
Management
- Hemodynamic support
- Source control ( post-operative wounds should be explored even if they do not appear to be infected)
Antibiotics
Clindamycin 900mg IV or 25 mg/kg to 40 mg/kg in children every 8hrs in adults AND Vancomycin 15 to 20 mg/kg or 40 mg/kg in children every 8 to 12 hrs.
Emergency Medicine FOAM
References
https://www.uptodate.com/contents/staphylococcal-toxic-shock-syndrome