Toxic shock syndrome laboratory findings: Difference between revisions

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{{Toxic shock syndrome}}
{{Toxic shock syndrome}}
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{{CMG}},{{AE}}{{MIR}}
==Overview''':'''==
[[Laboratory findings template|Laboratory finding]]<nowiki/>s consistent with the diagnosis of [[toxic shock syndrome]] (TSS) include [[leukocytosis]], [[anemia]] and [[thrombocytopenia]]. A positive [[blood culture]] is diagnostic for [[Streptococcus|Streptococcal]] TSS, although in other causes of TSS [[blood culture]] doesn't have a high value.


{{CMG}}
==Laboratory Findings==
The International Guideline Committee for diagnosis of [[septic shock]] recommends obtaining appropriate cultures that may include at least two [[blood cultures]], [[urine]], [[cerebrospinal fluid]], [[wounds]], respiratory secretions, or other body fluid cultures before [[antimicrobial]] therapy is initiated. In [[Toxic shock syndrome|TSS]] patients, [[blood culture]] for [[staphylococcus]] is not diagnostic, although blood culture for [[Streptococcus|streptococcal]] TSS is highly diagnostic.


==Laboratory Findings==
=== Primary General Electrolyte and Biomarker Studies<ref name="pmid8418347">{{cite journal |vauthors= |title=Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections |journal=JAMA |volume=269 |issue=3 |pages=390–1 |year=1993 |pmid=8418347 |doi= |url=}}</ref><ref name="pmid3890787">{{cite journal |vauthors=Adams EM, Gudmundsson S, Yocum DE, Haselby RC, Craig WA, Sundstrom WR |title=Streptococcal myositis |journal=Arch. Intern. Med. |volume=145 |issue=6 |pages=1020–3 |year=1985 |pmid=3890787 |doi= |url=}}</ref> ===
* [[Renal failure]] (serum creatinine > 2x normal)
{| class="wikitable"
* [[Hepatic]] [[inflammation]] (AST, ALT > 2x normal)
! align="center" style="background:#4479BA; color: #FFFFFF;" |Laboratory Tests
* [[Thrombocytopenia]] (platelet count < 100,000 / mm³)
! align="center" style="background:#4479BA; color: #FFFFFF;" |Result
* In some cases, blood cultures may be positive for growth of S. aureus.
|-
| rowspan="4" align="center" style="background:#DCDCDC;"|[[Complete blood count]] (CBC)
|[[Leukocytosis]] with a left shift
|-
|[[Hematocrit]] levels up to 80 percent have been reported
|-
|[[Thrombocytopenia]] with [[Platelet|platelets]] <100 x 10^3/microliter
|-
|[[Anemia]]
|-
|align="center" style="background:#DCDCDC;"|Blood culture
|[[Bacteremia]]
|-
| rowspan="2" align="center" style="background:#DCDCDC;"|[[Renal function tests]]
|Elevated serum [[BUN]] and [[creatinine]]
|-
|[[Urine appearance|Urine Analysis]]: [[Hemoglobinuria]]
|-
| rowspan="2" align="center" style="background:#DCDCDC;"|[[Liver function tests|Liver Function Tests]]
|Elevated [[Transaminase|transaminases]] and [[bilirubin]]
|-
|[[Hypoalbuminemia]]
|-
|align="center" style="background:#DCDCDC;"|Serum [[lactic acid]]
|[[Lactic acidosis|Hyper lactic acidosis]]
|-
| rowspan="3" align="center" style="background:#DCDCDC;"|Metabolic tests
|[[Hypocalcemia]]
|-
|[[Hyponatremia]]
|-
|[[Hypophosphatemia]]
|-
| rowspan="2"v align="center" style="background:#DCDCDC;"|Blood gas analysis:
Venous blood gas (VBG) and arterial blood gas analysis (ABG)
|[[Hypoxemia]] may be present as a result of [[pulmonary edema]] and [[pleural effusion]]
[[Metabolic acidosis]]
|-
| align="center" style="background:#DCDCDC;"|[[Creatine phosphokinase|Creatine phosphokinase (CPK)]]
|Elevated
|}
 
=== Specialized Laboratory Tests<ref name="pmid7069224">{{cite journal |vauthors=Davis JP, Osterholm MT, Helms CM, Vergeront JM, Wintermeyer LA, Forfang JC, Judy LA, Rondeau J, Schell WL |title=Tri-state toxic-shock syndrome study. II. Clinical and laboratory findings |journal=J. Infect. Dis. |volume=145 |issue=4 |pages=441–8 |year=1982 |pmid=7069224 |doi= |url=}}</ref> ===
{| class="wikitable"
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Laboratory Tests
! align="center" style="background:#4479BA; color: #FFFFFF;" |Result
|-
|align="center" style="background:#DCDCDC;"|Blood microscopy and culture (blood, wound, fluid, tissue)
|Positive for group A [[streptococcus]] or [[Staphylococcus aureus]]
|-
| align="center" style="background:#DCDCDC;"|[[Prothrombin time]]
|Prolonged in [[Staphylococcus|staphylococcal]] disease in conjunction with [[DIC]]
|-
| align="center" style="background:#DCDCDC;"|[[Partial thromboplastin time]]
|Prolonged in [[staphylococcal]] disease in conjunction with [[DIC]]
|-
| align="center" style="background:#DCDCDC;"|[[Creatine kinase|Creatine kinase (CK)]]
|Elevated in [[necrotizing fasciitis]] or [[myositis]] and in some [[Staphylococcus|staphylococcal]] disease
|-
| align="center" style="background:#DCDCDC;"|[[Polymerase chain reaction|Polymerase chain reaction (PCR)]]
|Protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks
|-
| align="center" style="background:#DCDCDC;"|Serotyping
|Evidence of [[Streptococcus|streptococcal]] [[Exotoxin|exotoxins]]
|}


==References==
==References ==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 00:27, 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:

Laboratory findings consistent with the diagnosis of toxic shock syndrome (TSS) include leukocytosis, anemia and thrombocytopenia. A positive blood culture is diagnostic for Streptococcal TSS, although in other causes of TSS blood culture doesn't have a high value.

Laboratory Findings

The International Guideline Committee for diagnosis of septic shock recommends obtaining appropriate cultures that may include at least two blood cultures, urine, cerebrospinal fluid, wounds, respiratory secretions, or other body fluid cultures before antimicrobial therapy is initiated. In TSS patients, blood culture for staphylococcus is not diagnostic, although blood culture for streptococcal TSS is highly diagnostic.

Primary General Electrolyte and Biomarker Studies[1][2]

Laboratory Tests Result
Complete blood count (CBC) Leukocytosis with a left shift
Hematocrit levels up to 80 percent have been reported
Thrombocytopenia with platelets <100 x 10^3/microliter
Anemia
Blood culture Bacteremia
Renal function tests Elevated serum BUN and creatinine
Urine Analysis: Hemoglobinuria
Liver Function Tests Elevated transaminases and bilirubin
Hypoalbuminemia
Serum lactic acid Hyper lactic acidosis
Metabolic tests Hypocalcemia
Hyponatremia
Hypophosphatemia
Blood gas analysis:

Venous blood gas (VBG) and arterial blood gas analysis (ABG)

Hypoxemia may be present as a result of pulmonary edema and pleural effusion

Metabolic acidosis

Creatine phosphokinase (CPK) Elevated

Specialized Laboratory Tests[3]

Laboratory Tests Result
Blood microscopy and culture (blood, wound, fluid, tissue) Positive for group A streptococcus or Staphylococcus aureus
Prothrombin time Prolonged in staphylococcal disease in conjunction with DIC
Partial thromboplastin time Prolonged in staphylococcal disease in conjunction with DIC
Creatine kinase (CK) Elevated in necrotizing fasciitis or myositis and in some staphylococcal disease
Polymerase chain reaction (PCR) Protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks
Serotyping Evidence of streptococcal exotoxins

References

  1. ↑ "Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections". JAMA. 269 (3): 390–1. 1993. PMID 8418347.
  2. ↑ Adams EM, Gudmundsson S, Yocum DE, Haselby RC, Craig WA, Sundstrom WR (1985). "Streptococcal myositis". Arch. Intern. Med. 145 (6): 1020–3. PMID 3890787.
  3. ↑ Davis JP, Osterholm MT, Helms CM, Vergeront JM, Wintermeyer LA, Forfang JC, Judy LA, Rondeau J, Schell WL (1982). "Tri-state toxic-shock syndrome study. II. Clinical and laboratory findings". J. Infect. Dis. 145 (4): 441–8. PMID 7069224.


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