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The diagnosis of [[Staphylococcus|Staphylococcal]] [[toxic shock syndrome]] (TSS) is based upon clinical presentation as no confirmatory diagnostic criteria is developed yet. An epidemiological clinical criteria list have 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, mean that a patient can not be excluded from disease based on the absence of one of these criterias when it come to [[diagnosis]] terms. This [[criteria]] list means 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 criterias, 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> | The diagnosis of [[Staphylococcus|Staphylococcal]] [[toxic shock syndrome]] (TSS) is based upon clinical presentation as no confirmatory diagnostic criteria is developed yet. An epidemiological clinical criteria list have 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, mean that a patient can not be excluded from disease based on the absence of one of these criterias when it come to [[diagnosis]] terms. This [[criteria]] list means 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 criterias, 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> | ||
TSS [[illness]] diagnosis can be | TSS [[illness]] 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]] | ||
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** [[Gastrointestinal]]: | ** [[Gastrointestinal]]: | ||
*** [[Vomiting]] | *** [[Vomiting]] | ||
*** [[ | *** [[Diarrhea]] at onset of [[illness]] (especially watery) | ||
** [[Muscular]]: | ** [[Muscular]]: | ||
*** Severe myalgia | *** Severe myalgia | ||
*** | *** Increased creatine phosphokinase (CPK) level at least twice the upper limit of normal | ||
** [[Mucous membrane]]: | ** [[Mucous membrane]] [[Conjunctival disease|inflammation]]: | ||
***[[Vaginal]] | ***[[Vaginal]] | ||
***[[Oropharyngeal]] | ***[[Oropharyngeal]] | ||
***[[Conjunctival disease|Conjunctival | ***[[Conjunctival disease|Conjunctival]] | ||
** [[Kidney|Renal]]: | ** [[Kidney|Renal]]: | ||
*** [[Blood urea nitrogen]] or [[creatinine]] at least twice the upper limit of normal | *** [[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]] | *** 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: | ** [[Hepatic]]: Increase of the hepatic enzymes twice the upper limit of normal for laboratory: | ||
| Line 41: | Line 41: | ||
If the result of the following tests become negative, it can be considered a positive criteria for TSS: | 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]]. | * [[Blood]] culture: Blood culture may be positive for [[Staphylococcus aureus]]. | ||
* [[cerebrospinal fluid]] cultures | * C[[cerebrospinal fluid|erebrospinal fluid]] cultures | ||
* Negative [[Serology|serologies]] for: | * Negative [[Serology|serologies]] for: | ||
** [[Rocky Mountain spotted fever]] | ** [[Rocky Mountain spotted fever|Rocky Mountain Spotted Fever]] | ||
** [[Leptospirosis]] | ** [[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> | ** [[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> | ||
| Line 52: | Line 52: | ||
{| class="wikitable" | {| class="wikitable" | ||
!Disease presentation | !Disease presentation | ||
! colspan="2" | | ! colspan="2" |Criteria | ||
!Definite case | !Definite case | ||
!Suspected case | !Suspected case | ||
| Line 72: | Line 72: | ||
** [[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]] | ||
|- | |- | ||
| Line 95: | Line 95: | ||
|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]] | |||
# [[Histologic]] confirmation: [[Gram-positive cocci]] in a [[Necrotic tissue|necrotic soft tissue infection]] | # [[Histologic]] confirmation: [[Gram-positive cocci]] in a [[Necrotic tissue|necrotic soft tissue infection]] | ||
|} | |} | ||
Revision as of 20:13, 15 May 2017
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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.
Diagnostic Criteria
Toxic Shock Syndrome (Other Than Streptococcal) (TSS)
Clinical Criteria
The diagnosis of Staphylococcal toxic shock syndrome (TSS) is based upon clinical presentation as no confirmatory diagnostic criteria is developed yet. An epidemiological clinical criteria list have 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, mean that a patient can not be excluded from disease based on the absence of one of these criterias when it come to diagnosis terms. This criteria list means 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 criterias, the case may be considered as a probable/susceptible case.[1]
TSS illness 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 | A2+B |
| B. Clinical signs of severity |
| |||
| Necrotizing fasciitis | A. Clinical Criteria |
|
A+B1 | A+B2
A+B3 |
| B. Isolation of group A Streptococcus |
a) streptolysin O b) DNase B
| |||
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).