Toxic shock syndrome differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Differentiating Toxic Shock Syndrome from other Diseases
Toxic shock syndrome requires all 3 manifestations of fever, hypotension and diffuse scarlatiniform rash (innumerable small red papules that are diffusely distributed plus erythema, which blanches and desquamates one or two weeks after onset of illness). It presents with various signs of infection, hemodynamic dysfunction and organ failure.
Clinical presentation of sepsis and rash needs to be differentiated from other diseases like:
- Staphylococcal scalded skin syndrome
- Exfoliative erythroderma syndrome
- Erythema multiforme major
- Drug eruption
| Features | Toxic shock syndrome | Kawasaki disease | Scarlet fever |
|---|---|---|---|
| Predisposing factors | Occurs in association with vaginitis during menstruation following tampon use (S. aureus); as a complication of soft tissue infections (S. pyogenes or GAS) or in females undergoing medical abortion (C. sordelii). | Interaction of genetic and environmental factors, possibly including an infection in combination with genetic predisposition to an autoimmune mechanism (autoimmune vasculitis) | Occurs after streptococcal pharyngitis/tonsillitis |
| Hypotension | Commonly present | Not present | Uncommon |
| Diarrhea | Present | Not present | |
| Pastia's sign (puncta and skin crease accentuation of the erythema) | Not present | Not present | Present |
| Renal faliure | Present | Not present | Uncommon |
| Pyuria | Renal origin | Uretheral origin | |
| Lymphadenopathy | Not present | Present(acute, non-purulent, cervical) | Cervical lymphadenopathy may be present |
| Metabolic and electrolyte imbalances | Present (hyponatremia and uremia) | Not present | |
| Epidemiology | Occurs in both adults and children (9:1 female predominance) | Occurs in children, usually age 1-4 years | Distributed equally among both genders |