Toxic shock syndrome laboratory findings: Difference between revisions

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{{CMG}}
{{CMG}}
==Overview''':'''==
==Overview''':'''==
:An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name]
Laboratory findings consistent with the diagnosis of toxic shock syndrome (TSS) include [[leukocytosis]], [[anemia]] and [[thrombocytopenia]].
:Laboratory findings consistent with the diagnosis of toxic shock syndrome (TSS) include [[leukocytosis]], [[anemia]] and [[thrombocytopenia]].
 
:There are no diagnostic lab findings associated with [disease name].
A positive blood culture is diagnostic for Streptococcal TSS, although in other causes of TSS blood culture doesn't have a high value.
*'''Additional Sentences:'''
:Additional Sentence 1: [Test] is usually normal among patients with [disease name].
:Additional Sentence 2: Some patients with [disease name] may have elevated/reduced concentrations of [test], which is usually suggestive of [progression/complication].


:
==Laboratory Findings==
==Laboratory Findings==
The international guideline committee for diagnosis of septic shock recommends obtaining appropriate [[culture]]s that may include at least two [[blood cultures]], [[urine]], [[cerebrospinal fluid]], wounds, respiratory secretions, or other body fluid cultures before [[antimicrobial]] therapy is initiated. If such cultures do not cause significant delay in antibiotic administration, then other tests that may be done include [[blood gases]], kidney function tests, [[platelet count]], [[white blood cell count]], [[blood]] differential, [[fibrin]] degradation products, and [[peripheral smear]].
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.


===Electrolyte and Biomarker Studies===
===Primary General Electrolyte and Biomarker Studies===
====Baseline tests====
{| class="wikitable"
*[[Complete blood count]]:
!
*Serum [[calcium]] levels - can reflect underlying disease states (e.g, severe [[hypercalcemia]] may reflect underlying [[malignancy]] or [[hyperparathyroidism]]; [[hypocalcemia]] can contribute to osteoporosis)
!
*Serum [[phosphate]] and [[alkaline phosphatase]]
!
*Serum 25 (OH) [[vitamin D]] levels
!
*[[Serum creatinine]] levels - reflect [[chronic renal failure]] which leads to [[renal osteodystrophy]]
|-
*Serum [[magnesium]] levels - important in calcium homeostasis
|[[Complete blood count]] (CBC)
*Serum iron and ferritin levels - for excluding [[hemochromatosis]]
|leukocytosis with a left shift; anemia; thrombocytopenia with platelets <100 x 10^3/microliter
*[[Liver function tests]] ([[alanine aminotransferase]], [[aspartate aminotransferase]], [[gamma-glutamyl transferase]], [[bilirubin]]) - aids in diagnosing alcoholism
*[[Thyroid function tests]]
Serum lactate


●Renal and liver function tests: Elevated blood urea nitrogen (BUN), creatinine, and transaminases are usually due to shock-induced end-organ damage (eg, acute kidney injury, shock liver).
[[Hematocrit]] levels up to 80 percent have been reported
|
|
|-
|lood culture
|Bacteremia
|
|
|-
|Renal function tests
|serum BUN and creatinine: elevated
|
|
|-
|
|Urine Analysis (UA): hemoglobinuria
|
|
|-
|Liver Function Tests
([[alanine aminotransferase]], [[aspartate aminotransferase]], [[gamma-glutamyl transferase]], [[bilirubin]])
|elevated transaminases and bilirubin


hypo- or hypernatremia, hypo- or hyperkalemia, low urinary sodium concentration, or fractional excretion of sodium <1 percent may indicate hypovolemia.
,[[hypoalbuminemia]]
|
|
|-
|Serum lactic acid
|elevated in severe sepsis and septic shock
|
|
|-
|Metabolic tests
|hyponatremia, hypokalemia, hypophosphatemia


●Complete blood count and differential:leukocytosis may suggest septic shock.  A high hematocrit may suggest hemoconcentration from hypovolemia. A low white blood cell count and especially a bandemia are more worrisome for sepsis in the setting of undifferentiated shock
[[hypocalcemia]], [[hyponatremia]], and [[hypophosphatemia]]
 
|
●Coagulation studies and D-dimer level
|
 
|-
●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
|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
elevated levels of [[Creatine phosphokinase|creatine phosphokinase (CPK)]]
|
* [[Renal failure]] can lead to [[Metabolic Control Analysis|metabolic abnormalitie]]<nowiki/>s such as [[hypocalcemia]], [[hyponatremia]], [[hypoalbuminemia]], and [[hypophosphatemia]].
|
[[CBC|hematologic abnormalities]], especially [[anemia]] and [[thrombocytopenia]].
|-
 
|[[Creatine phosphokinase|Creatine phosphokinase (CPK)]]
[[bacteremia]],
|Elevated
|
|
|}


[[leukocytosis]], [[hemoconcentration]],
* Profound [[leukocytosis]] ([[leukemoid reaction]]) consisting of white blood cell (WBC) count >50,000 cells/microL, which can increase to 200,000 cells/microL within 48 hours
* An increased percentage of mature and immature [[Neutrophil|neutrophils]] and increased absolute numbers of [[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]]
* [[Leukemoid reaction]] is highly predictive of mortality
* [[Leukemoid reaction]] is highly predictive of mortality
[[Hematocrit]] levels up to 80 percent have been reported


due to [[capillary]] leak from toxin-mediated changes in the vascular endothelium and ahypoalbuminemia
due to [[capillary]] leak from toxin-mediated changes in the vascular endothelium and a


A diagnosis of probable GAS TSS can be made if GAS is isolated from a normally nonsterile site (eg, throat, vagina, skin lesion) but the patient fulfills the other criteria noted above and no other etiology for the illness is identified.
A diagnosis of probable GAS TSS can be made if GAS is isolated from a normally nonsterile site (eg, throat, vagina, skin lesion) but the patient fulfills the other criteria noted above and no other etiology for the illness is identified.
Line 55: Line 78:
Recovery of the organism from blood cultures usually takes 8 to 24 hours. Gram stain of involved tissue demonstrating gram-positive cocci in pairs and chains can provide an early diagnostic clue in many cases.....8418347
Recovery of the organism from blood cultures usually takes 8 to 24 hours. Gram stain of involved tissue demonstrating gram-positive cocci in pairs and chains can provide an early diagnostic clue in many cases.....8418347


Bacteremia is common.....3890787
is common.....


Cultures from mucosal and wound sites should be obtained because S. aureus isolates can be tested for toxin production in research laboratories.acute and convalescent serum can be analyzed for antibody responses to various S. aureus exotoxins. The presence of a strain of S. aureus that produces toxin in a patient who does not have acute phase antibody to the toxin is highly suggestive of TSS.
Cultures from mucosal and wound sites should be obtained because S. aureus isolates can be tested for toxin production in research laboratories.acute and convalescent serum can be analyzed for antibody responses to various S. aureus exotoxins. The presence of a strain of S. aureus that produces toxin in a patient who does not have acute phase antibody to the toxin is highly suggestive of TSS.


Polymerase chain reaction (PCR) analysis of peripheral blood T cells from adults with TSS has shown a protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks.  
analysis of peripheral blood T cells from adults with TSS has shown a protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks.  
{| class="wikitable"
|[null serotyping]
|evidence of streptococcal exotoxins
|}
{| class="wikitable"
{| class="wikitable"
|[null microscopy and culture (blood, wound, fluid, tissue)]
|Blood microscopy and culture (blood, wound, fluid, tissue)
|positive for group A streptococcus or Staphylococcus aureus
|positive for group A streptococcus or Staphylococcus aureus
|-
|-
|[null CBC]
|Prothrombin time
|leukocytosis with a left shift; anemia; thrombocytopenia with platelets <100 x 10^3/microliter
|-
|[null prothrombin time]
|prolonged in staphylococcal disease in conjunction with DIC
|prolonged in staphylococcal disease in conjunction with DIC
|-
|-
|[null partial thromboplastin time]
|Partial thromboplastin time
|prolonged in staphylococcal disease in conjunction with DIC
|prolonged in staphylococcal disease in conjunction with DIC
|-
|-
|[null serum BUN and creatinine]
|Creatine kinase (CK)
|elevated
|-
|[null urinalysis]
|hemoglobinuria
|-
|[null LFTs]
|elevated transaminases and bilirubin
|-
|[null creatine kinase (CK)]
|elevated in necrotizing fasciitis or myositis and in some staphylococcal disease
|elevated in necrotizing fasciitis or myositis and in some staphylococcal disease
|-
|-
|[null serum calcium]
|Polymerase chain reaction (PCR)
|low in streptococcal disease
|protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks
|-
|-
|[null serum albumin]
|serotyping
|low in streptococcal disease
|evidence of streptococcal exotoxins
|-
|-
|[null serum lactic acid]
|
|elevated in severe sepsis and septic shock
|
|}
|}


Revision as of 23:09, 14 May 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

Complete blood count (CBC) leukocytosis with a left shift; anemia; thrombocytopenia with platelets <100 x 10^3/microliter

Hematocrit levels up to 80 percent have been reported

lood culture Bacteremia
Renal function tests serum BUN and creatinine: elevated
Urine Analysis (UA): hemoglobinuria
Liver Function Tests

(alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, bilirubin)

elevated transaminases and bilirubin

,hypoalbuminemia

Serum lactic acid elevated in severe sepsis and septic shock
Metabolic tests hyponatremia, hypokalemia, hypophosphatemia

hypocalcemia, hyponatremia, and 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
Creatine phosphokinase (CPK) Elevated

due to capillary leak from toxin-mediated changes in the vascular endothelium and a

A diagnosis of probable GAS TSS can be made if GAS is isolated from a normally nonsterile site (eg, throat, vagina, skin lesion) but the patient fulfills the other criteria noted above and no other etiology for the illness is identified.

Recovery of the organism from blood cultures usually takes 8 to 24 hours. Gram stain of involved tissue demonstrating gram-positive cocci in pairs and chains can provide an early diagnostic clue in many cases.....8418347

is common.....

Cultures from mucosal and wound sites should be obtained because S. aureus isolates can be tested for toxin production in research laboratories.acute and convalescent serum can be analyzed for antibody responses to various S. aureus exotoxins. The presence of a strain of S. aureus that produces toxin in a patient who does not have acute phase antibody to the toxin is highly suggestive of TSS.

analysis of peripheral blood T cells from adults with TSS has shown a protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks.

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


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