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. | Diagnosis of [[Toxic shock syndrome|Toxic Shock Syndrome]] (TSS) is mainly based on the clinical presentation. [[fever]] >38.9°C, [[hypotension]], diffuse [[erythroderma]], [[desquamation]] are the main clinical features of TSS. | ||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
=== Toxic Shock Syndrome (Other Than Streptococcal) (TSS) === | === Toxic Shock Syndrome (Other Than Streptococcal) (TSS) === | ||
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2. From a nonsterile body site | 2. From a nonsterile body site | ||
| rowspan="2" |A1+B | | rowspan="2" |A1+B | ||
(B for total criteria) | |||
| rowspan="2" |A2+B | | rowspan="2" |A2+B | ||
(B for total criteria) | |||
|- | |- | ||
|B. Clinical signs of severity | |B. Clinical signs of severity | ||
| Line 89: | Line 91: | ||
*** [[Renal failure]] | *** [[Renal failure]] | ||
| rowspan="2" |A+B1 | | rowspan="2" |A+B1 | ||
(A for total criteria) | |||
| rowspan="2" |A+B2 | | rowspan="2" |A+B2 | ||
A+B3 | A+B3 | ||
(A for total criteria) | |||
|- | |- | ||
|B. Isolation of group A [[Streptococcus]] | |B. Isolation of group A [[Streptococcus]] | ||
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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. fever >38.9°C, hypotension, diffuse erythroderma, desquamation are the main clinical features of TSS.
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 for laboratory:
- Hematologic: Platelets less than 100,000/mm3
- Central nervous system:
- Disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent.[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
(B for total criteria) |
A2+B
(B for total criteria) |
| B. Clinical signs of severity |
| |||
| Necrotizing fasciitis | A. Clinical Criteria |
|
A+B1
(A for total criteria) |
A+B2
A+B3 (A for total criteria) |
| 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).