Toxic shock syndrome diagnostic criteria: Difference between revisions
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== Overview == | == Overview == | ||
Diagnosis of [[Toxic shock syndrome|Toxic Shock Syndrome]] (TSS) is mainly based on the clinical presentation including [[fever]] >38.9°C, [[hypotension]], diffuse [[erythroderma]], [[desquamation]]. | |||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
=== Toxic Shock Syndrome (Other Than Streptococcal) (TSS) === | === Toxic Shock Syndrome (Other Than Streptococcal) (TSS) === | ||
==== Clinical Criteria ==== | ==== Clinical Criteria ==== | ||
The diagnosis of [[Staphylococcus|Staphylococcal]] [[toxic shock syndrome]] (TSS) is based upon clinical presentation | The diagnosis of [[Staphylococcus|Staphylococcal]] [[toxic shock syndrome]] (TSS) is based upon clinical presentation. An epidemiological clinical criteria list has been established by United States Centers for Disease Control and Prevention ([[Centers for Disease Control and Prevention|CDC]]) for [[Epidemiology|epidemiologic]] studies on [[Staphylococcus|Staphylococcal]] TSS. This criteria list is epidemiologicaly usable only, meaning that a patient can not be excluded from disease based on the absence of one of these criteria. This [[criteria]] list points that a confirmed case is someone who has [[fever]] >38.9°C, [[hypotension]], diffuse [[erythroderma]], [[desquamation]] (unless the patient dies before [[desquamation]] can occur), and involvement of at least three organ systems. If a patient misses one of these criteria, the case may be considered as a probable/susceptible case.<ref name="pmid7289007">{{cite journal |vauthors=Tofte RW, Williams DN |title=Toxic shock syndrome. Evidence of a broad clinical spectrum |journal=JAMA |volume=246 |issue=19 |pages=2163–7 |year=1981 |pmid=7289007 |doi= |url=}}</ref> | ||
[[Toxic shock syndrome|TSS]] diagnosis can be made with the following clinical manifestations: | |||
* [[Fever]]: [[Temperature]] greater than or equal to 102.0°F (greater than or equal to 38.9°C) | * [[Fever]]: [[Temperature]] greater than or equal to 102.0°F (greater than or equal to 38.9°C) | ||
* [[Rash]]: Diffuse [[macular]] [[erythroderma]] | * [[Rash]]: Diffuse [[macular]] [[erythroderma]] | ||
| Line 18: | Line 17: | ||
* [[Hypotension]]: [[Systolic blood pressure]] less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years | * [[Hypotension]]: [[Systolic blood pressure]] less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years | ||
* [[Multiorgan failure|Multiorgan involvement]] (three or more of the following organ systems): | * [[Multiorgan failure|Multiorgan involvement]] (three or more of the following organ systems): | ||
** [[Gastrointestinal]]: [[Vomiting]] | ** [[Gastrointestinal]]: | ||
** [[Muscular]]: Severe myalgia | *** [[Vomiting]] | ||
** [[Mucous membrane]]: [[Vaginal]] | *** [[Diarrhea]] at onset of [[illness]] (especially watery) | ||
** [[Kidney|Renal]]: [[Blood urea nitrogen]] or [[creatinine]] at least twice the upper limit of normal | ** [[Muscular]]: | ||
** [[Hepatic]]: [[Bilirubin|Total bilirubin]] | *** Severe [[myalgia]] | ||
** [[Hematologic]]: [[Platelets]] less than 100,000/mm3 | *** Increased [[creatine phosphokinase]] ([[CPK]]) level at least twice the upper limit of normal | ||
** [[Central nervous system]]: [[Disorientation]] or alterations in [[consciousness]] without [[focal neurologic signs]] | ** [[Mucous membrane]] [[Conjunctival disease|inflammation]]: | ||
***[[Vaginal]] | |||
***[[Oropharyngeal]] | |||
***[[Conjunctival disease|Conjunctival]] | |||
** [[Kidney|Renal]]: | |||
*** [[Blood urea nitrogen]] or [[creatinine]] at least twice the upper limit of normal. | |||
*** Urinary sediment with [[pyuria]] (greater than or equal to 5 [[leukocytes]] per high-power field) in the absence of [[urinary tract infection]] | |||
** [[Hepatic]]: Increase of the hepatic enzymes twice the upper limit of normal. | |||
*** [[Bilirubin|Total bilirubin]] | |||
*** [[Alanine aminotransferase|Alanine]] [[aminotransferase]] | |||
*** [[Aspartate|Aspartate aminotransferase]] | |||
** [[Hematologic]]: | |||
*** [[Platelets]] less than 100,000/mm3 | |||
** [[Central nervous system]]: | |||
*** [[Disorientation]] or alterations in [[consciousness]] without [[focal neurologic signs]].<ref name="pmid2294395"><nowiki>cite journal |vauthors= |title=Repeat injuries in an inner city population--Philadelphia, 1987-1988 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=39 |issue=1 |pages=1–3 |year=1990 |pmid=2294395 |doi= |url=}}</nowiki></ref><ref name="pmid9148133">{{cite journal |vauthors= |title=Case definitions for infectious conditions under public health surveillance. Centers for Disease Control and Prevention |journal=MMWR Recomm Rep |volume=46 |issue=RR-10 |pages=1–55 |year=1997 |pmid=9148133 |doi= |url=}}</ref> | |||
==== Laboratory Criteria for Diagnosis ==== | ==== Laboratory Criteria for Diagnosis ==== | ||
If the result of the following tests become negative, it can be considered a positive criteria for TSS: | |||
* [[Blood]] | * [[Blood]] culture: Blood culture may be positive for [[Staphylococcus aureus]]. | ||
* Negative [[Serology|serologies]] for [[Rocky Mountain spotted fever]] | * C[[cerebrospinal fluid|erebrospinal fluid]] cultures | ||
* Negative [[Serology|serologies]] for: | |||
** [[Rocky Mountain spotted fever|Rocky Mountain Spotted Fever]] | |||
** [[Leptospirosis]] | |||
** [[Measles]]<ref name="urlToxic Shock Syndrome (Other Than Streptococcal) | 2011 Case Definition">{{cite web |url=https://wwwn.cdc.gov/nndss/conditions/toxic-shock-syndrome-other-than-streptococcal/case-definition/2011/ |title=Toxic Shock Syndrome (Other Than Streptococcal) | 2011 Case Definition |format= |work= |accessdate=}}</ref> | |||
=== Streptococcal TSS === | === Streptococcal TSS === | ||
There is a subtle difference between [[Streptococcus|Streptococcal]] TSS and other types. [[Streptococcus|Group A Streptococcus(GAS]]) can be isolated in GAS-related TSS patients. | There is a subtle difference between [[Streptococcus|Streptococcal]] TSS and other types. [[Streptococcus|Group A Streptococcus(GAS]]) can be isolated in GAS-related TSS patients. | ||
====Clinical and biochemical criteria of [[Streptococcus|streptococcal]] TSS and [[necrotizing fasciitis]] (NF).<ref name="urlwwwnc.cdc.gov">{{cite web |url=https://wwwnc.cdc.gov/eid/article/1/3/pdfs/95-0301.pdf |title=wwwnc.cdc.gov |format= |work= |accessdate=}}</ref>==== | |||
{| class="wikitable" | {| class="wikitable" | ||
!Disease | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Disease Presentation | ||
! colspan="2" | | ! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Criteria | ||
!Definite case | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Definite case | ||
!Suspected case | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Suspected case | ||
|- | |- | ||
! rowspan="2" |Streptococal TSS | ! rowspan="2" align="center" style="background:#DCDCDC;"|Streptococal TSS | ||
|A. Isolation of group A [[Streptococcus]] | |A. Isolation of group A [[Streptococcus]] | ||
|1. From a [[sterile]] site | |1. From a [[sterile]] site | ||
2. From a nonsterile body site | 2. From a nonsterile body site | ||
| rowspan="2" |A1+B | | rowspan="2" |A1 '''+''' B(complete) | ||
| rowspan="2" |A2+B | |||
| rowspan="2" |A2 '''+''' B(complete) | |||
|- | |- | ||
|B. Clinical signs of severity | |B. Clinical signs of severity | ||
| Line 52: | Line 71: | ||
* [[Hypotension]] | * [[Hypotension]] | ||
* Clinical and laboratory abnormalities (requires two or more of the following): | * Clinical and laboratory abnormalities (requires two or more of the following): | ||
** [[Renal Failure]] | ** [[Renal Failure]] | ||
** [[Coagulopathy]] | ** [[Coagulopathy]] | ||
** [[Hepatic failure]] | ** [[Hepatic failure]] | ||
** [[Acute respiratory distress syndrome]](ARDS) | ** [[Acute respiratory distress syndrome]] (ARDS) | ||
** Extensive tissue [[necrosis]] | ** Extensive tissue [[necrosis]] i.e. necrotizing fasciitis | ||
** [[Erythematous]] [[rash]] | ** [[Erythematous]] [[rash]] | ||
|- | |- | ||
! rowspan="2" |Necrotizing fasciitis | ! rowspan="2" align="center" style="background:#DCDCDC;"|Necrotizing fasciitis | ||
|A. Clinical Criteria | |A. Clinical Criteria | ||
| | | | ||
| Line 73: | Line 91: | ||
*** [[Hepatic failure|Liver failure]] | *** [[Hepatic failure|Liver failure]] | ||
*** [[Renal failure]] | *** [[Renal failure]] | ||
| rowspan="2" |A+B1 | | rowspan="2" |A (complete) '''+''' B1 | ||
| rowspan="2" |A+B2 | |||
A+B3 | | rowspan="2" |A (complete) '''+''' B2 | ||
A(complete) '''+''' B3 | |||
|- | |- | ||
|B. Isolation of group A [[Streptococcus]] | |B. Isolation of group A [[Streptococcus]] | ||
| | | | ||
# Isolation of group A [[Streptococcus]] from a normally [[sterile]] body | # Isolation of group A [[Streptococcus]] from a normally [[sterile]] body sites | ||
# [[Serological testing|Serologic]] confirmation of group A [[Streptococcus|streptococcal]] infection by a 4-fold rise against: a) streptolysin O b) DNase B | # [[Serological testing|Serologic]] confirmation of group A [[Streptococcus|streptococcal]] infection by a 4-fold rise against: | ||
::a) streptolysin O b) [[DNase|DNase B]] | |||
:3. [[Histologic]] confirmation: [[Gram-positive cocci]] in a [[Necrotic tissue|necrotic soft tissue infection]] | |||
|} | |} | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Syndromes]] | [[Category:Syndromes]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 00:26, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Diagnosis of Toxic Shock Syndrome (TSS) is mainly based on the clinical presentation including fever >38.9°C, hypotension, diffuse erythroderma, desquamation.
Diagnostic Criteria
Toxic Shock Syndrome (Other Than Streptococcal) (TSS)
Clinical Criteria
The diagnosis of Staphylococcal toxic shock syndrome (TSS) is based upon clinical presentation. An epidemiological clinical criteria list has been established by United States Centers for Disease Control and Prevention (CDC) for epidemiologic studies on Staphylococcal TSS. This criteria list is epidemiologicaly usable only, meaning that a patient can not be excluded from disease based on the absence of one of these criteria. This criteria list points that a confirmed case is someone who has fever >38.9°C, hypotension, diffuse erythroderma, desquamation (unless the patient dies before desquamation can occur), and involvement of at least three organ systems. If a patient misses one of these criteria, the case may be considered as a probable/susceptible case.[1]
TSS diagnosis can be made with the following clinical manifestations:
- Fever: Temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C)
- Rash: Diffuse macular erythroderma
- Desquamation: 1-2 weeks after onset of rash
- Hypotension: Systolic blood pressure less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years
- Multiorgan involvement (three or more of the following organ systems):
- Gastrointestinal:
- Muscular:
- Severe myalgia
- Increased creatine phosphokinase (CPK) level at least twice the upper limit of normal
- Mucous membrane inflammation:
- Renal:
- Blood urea nitrogen or creatinine at least twice the upper limit of normal.
- Urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection
- Hepatic: Increase of the hepatic enzymes twice the upper limit of normal.
- Hematologic:
- Platelets less than 100,000/mm3
- Central nervous system:
- Disorientation or alterations in consciousness without focal neurologic signs.[2][3]
Laboratory Criteria for Diagnosis
If the result of the following tests become negative, it can be considered a positive criteria for TSS:
- Blood culture: Blood culture may be positive for Staphylococcus aureus.
- Cerebrospinal fluid cultures
- Negative serologies for:
Streptococcal TSS
There is a subtle difference between Streptococcal TSS and other types. Group A Streptococcus(GAS) can be isolated in GAS-related TSS patients.
Clinical and biochemical criteria of streptococcal TSS and necrotizing fasciitis (NF).[5]
| Disease Presentation | Criteria | Definite case | Suspected case | |
|---|---|---|---|---|
| Streptococal TSS | A. Isolation of group A Streptococcus | 1. From a sterile site
2. From a nonsterile body site |
A1 + B(complete) | A2 + B(complete) |
| B. Clinical signs of severity |
| |||
| Necrotizing fasciitis | A. Clinical Criteria |
|
A (complete) + B1 | A (complete) + B2
A(complete) + B3 |
| B. Isolation of group A Streptococcus |
| |||
References
- ↑ Tofte RW, Williams DN (1981). "Toxic shock syndrome. Evidence of a broad clinical spectrum". JAMA. 246 (19): 2163–7. PMID 7289007.
- ↑ cite journal |vauthors= |title=Repeat injuries in an inner city population--Philadelphia, 1987-1988 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=39 |issue=1 |pages=1–3 |year=1990 |pmid=2294395 |doi= |url=}}
- ↑ "Case definitions for infectious conditions under public health surveillance. Centers for Disease Control and Prevention". MMWR Recomm Rep. 46 (RR-10): 1–55. 1997. PMID 9148133.
- ↑ "Toxic Shock Syndrome (Other Than Streptococcal) | 2011 Case Definition".
- ↑ "wwwnc.cdc.gov" (PDF).