Toxic shock syndrome laboratory findings: Difference between revisions
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{{CMG}},{{AE}}{{MIR}} | {{CMG}},{{AE}}{{MIR}} | ||
==Overview''':'''== | ==Overview''':'''== | ||
Laboratory findings consistent with the diagnosis of toxic shock syndrome (TSS) include [[leukocytosis]], [[anemia]] and [[thrombocytopenia]]. | [[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 Streptococcal TSS, although in other causes of TSS blood culture doesn't have a high value. | A positive [[blood culture]] is diagnostic for [[Streptococcus|Streptococcal]] TSS, although in other causes of TSS [[blood culture]] doesn't have a high value. | ||
==Laboratory Findings== | ==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. | 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. | ||
=== 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> === | === 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> === | ||
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|- | |- | ||
| rowspan="4" |[[Complete blood count]] (CBC) | | rowspan="4" |[[Complete blood count]] (CBC) | ||
|Leukocytosis with a left shift | |[[Leukocytosis]] with a left shift | ||
|- | |- | ||
|[[Hematocrit]] levels up to 80 percent have been reported | |[[Hematocrit]] levels up to 80 percent have been reported | ||
|- | |- | ||
|Thrombocytopenia with platelets <100 x 10^3/microliter | |[[Thrombocytopenia]] with [[Platelet|platelets]] <100 x 10^3/microliter | ||
|- | |- | ||
|Anemia | |[[Anemia]] | ||
|- | |- | ||
|Blood culture | |Blood culture | ||
|Bacteremia | |[[Bacteremia]] | ||
|- | |- | ||
| rowspan="2" |Renal function tests | | rowspan="2" |[[Renal function tests]] | ||
|Elevated serum BUN and creatinine | |Elevated serum [[BUN]] and [[creatinine]] | ||
|- | |- | ||
|Urine Analysis | |[[Urine appearance|Urine Analysis]]: [[Hemoglobinuria]] | ||
|- | |- | ||
| rowspan="2" |Liver Function Tests | | rowspan="2" |[[Liver function tests|Liver Function Tests]] | ||
|Elevated transaminases and bilirubin | |Elevated [[Transaminase|transaminases]] and [[bilirubin]] | ||
|- | |- | ||
|[[hypoalbuminemia]] | |[[hypoalbuminemia]] | ||
|- | |- | ||
|Serum lactic acid | |Serum [[lactic acid]] | ||
|Elevated | |Elevated | ||
|- | |- | ||
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| rowspan="2" |Blood gas analysis: | | rowspan="2" |Blood gas analysis: | ||
Venous blood gas (VBG) and arterial blood gas analysis (ABG) | Venous blood gas (VBG) and arterial blood gas analysis (ABG) | ||
|Hypoxemia may be present as a result of pulmonary edema and pleural effusion | |[[Hypoxemia]] may be present as a result of [[pulmonary edema]] and [[pleural effusion]] | ||
|- | |- | ||
|Metabolic acidosis and elevated pH | |[[Metabolic acidosis]] and elevated [[pH]] | ||
|- | |- | ||
|[[Creatine phosphokinase|Creatine phosphokinase (CPK)]] | |[[Creatine phosphokinase|Creatine phosphokinase (CPK)]] | ||
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|} | |} | ||
=== Specialized Laboratory Tests | === 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" | {| class="wikitable" | ||
|- | |- | ||
!Exam | |||
!Result | |||
|- | |- | ||
|Blood microscopy and culture (blood, wound, fluid, tissue) | |Blood microscopy and culture (blood, wound, fluid, tissue) | ||
|Positive for group A streptococcus | |Positive for group A [[streptococcus]] or [[Staphylococcus aureus]] | ||
|- | |- | ||
|Prothrombin time | |[[Prothrombin time]] | ||
|Prolonged in staphylococcal disease in conjunction with DIC | |Prolonged in [[Staphylococcus|staphylococcal]] disease in conjunction with [[DIC]] | ||
|- | |- | ||
|Partial thromboplastin time | |[[Partial thromboplastin time]] | ||
|Prolonged in staphylococcal disease in conjunction with DIC | |Prolonged in [[staphylococcal]] disease in conjunction with [[DIC]] | ||
|- | |- | ||
|Creatine kinase (CK) | |[[Creatine kinase|Creatine kinase (CK)]] | ||
|Elevated in necrotizing fasciitis or myositis and in some staphylococcal disease | |Elevated in [[necrotizing fasciitis]] or [[myositis]] and in some [[Staphylococcus|staphylococcal]] disease | ||
|- | |- | ||
|Polymerase chain reaction (PCR) | |[[Polymerase chain reaction|Polymerase chain reaction (PCR)]] | ||
|Protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks | |Protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks | ||
|- | |- | ||
|Serotyping | |Serotyping | ||
|Evidence of streptococcal exotoxins | |Evidence of [[Streptococcus|streptococcal]] [[Exotoxin|exotoxins]] | ||
|} | |} | ||
Revision as of 23:41, 14 May 2017
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 Exam | 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 | Elevated |
| 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 and elevated pH | |
| Creatine phosphokinase (CPK) | Elevated |
Specialized Laboratory Tests[3]
| Exam | 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
- ↑ "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.
- ↑ Adams EM, Gudmundsson S, Yocum DE, Haselby RC, Craig WA, Sundstrom WR (1985). "Streptococcal myositis". Arch. Intern. Med. 145 (6): 1020–3. PMID 3890787.
- ↑ 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.