Toxic shock syndrome history and symptoms
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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
A positive history of tampon usage is suggestive of staphylococcal toxic shock syndrome(TSS) and a positive history of recent extremity trauma is suggestive of Streptococcal TSS (the most common causes of disease). The most common symptoms of TSS include fever, erythroderma, and general viral infection symptoms like myalgia.
Less common symptom of TSS include desquamation (which occur after 1-3 weeks of disease onset).
History
It is necessary to obtain a detailed and thorough history from the patient to diagnose the type of TSS and determine its severeness. It provides insight into cause, precipitating factors and associated comorbid conditions. Complete history will help determine the correct therapy and helps in determining the prognosis. TSS patients may be disoriented due to encephalopathy complication therefore the patient interview may be difficult. In such cases history from the care givers or the family members may need to be obtained. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and past medical history have to be obtained.
Specific areas of focus when obtaining a history from the patient include:
- Recent fever
- Tampon usage[1]
- Recent trauma history
- Generalized associated symptoms like myalgias and weakness
- Flu like history
- Recent surgery history
General symptoms
These symptoms are common and can be found in all different causes of TSS. These are usually related to the shock itself and the hypersensitivity reaction which is related to bacterial antigen:
Common Symptoms
- fever
- Non-specific signs:
- Diffuse erythroderma
- edema of the extremities
Less common symptoms
- desquamation of palms and soles which particularly begins 1-3 weeks after disease beginning[2]
- Confusion or agitation (as a result of TSS complications e.g. encephalopathy)[3]
- Stupor or coma [4]
- Dyspnea (as a result of pulmonary edema and pleural effusion)
- Muscle cramps (as a result of metabolic disorders due to renal failure)[5]
Specific associated History and symptoms
Staphylococcal TSS
- Tampon usage
Streptococcal TSS
- History of cutaneous lesion, specially with local blunt trauma injury and penetrating tissue trauma[6][7]
- Cyanosis and bullae in extremities with a history of trauma[8]
Clostridium sordellii TSS
- Flu like symptoms and a history of pneumonia[9]
- History of surgery and surgical site infection[10][11]
TSS different causes and their symptoms
| type | symptoms | |
|---|---|---|
| Staphylococcal TSS | menstural | Skin manifestations: erythroderma
Conjunctival-scleral hemorrhage and hyperemia of the vaginal and oropharyngeal mucosa |
| non-menstural | ||
| Streptococcal TSS | GAS-related NF | skin and cutaneous lesions:
General Shock Signs: fever, hypotension, chills, malaise, sore throat, fatigue, myalgias, headache, abdominal pain, diarrhea, vomiting and orthostatic hypotension with dizziness or syncope |
| Clostridium sordellii TSS | - | nonspecific primary symptoms that may be misdiagnosed with viral infections like flu (nausea, vomiting, lethargy, influenza-like symptoms, and abdominal tenderness)
skin infection, bacteremia, and organ specific infections such as pneumonia, empyema, endocarditis, septic arthritis, and surgical site infection |
References
- ↑ Wharton M, Chorba TL, Vogt RL, Morse DL, Buehler JW (1990). "Case definitions for public health surveillance". MMWR Recomm Rep. 39 (RR-13): 1–43. PMID 2122225.
- ↑ "Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books".
- ↑ Olson RD, Stevens DL, Melish ME (1989). "Direct effects of purified staphylococcal toxic shock syndrome toxin 1 on myocardial function of isolated rabbit atria". Rev. Infect. Dis. 11 Suppl 1: S313–5. PMID 2928649.
- ↑ Rosene KA, Copass MK, Kastner LS, Nolan CM, Eschenbach DA (1982). "Persistent neuropsychological sequelae of toxic shock syndrome". Ann. Intern. Med. 96 (6 Pt 2): 865–70. PMID 7091958.
- ↑ Chesney RW, Chesney PJ, Davis JP, Segar WE (1981). "Renal manifestations of the staphylococcal toxic-shock syndrome". Am. J. Med. 71 (4): 583–8. PMID 7282746.
- ↑ Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E (1989). "Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A". N. Engl. J. Med. 321 (1): 1–7. doi:10.1056/NEJM198907063210101. PMID 2659990.
- ↑ Adams EM, Gudmundsson S, Yocum DE, Haselby RC, Craig WA, Sundstrom WR (1985). "Streptococcal myositis". Arch. Intern. Med. 145 (6): 1020–3. PMID 3890787.
- ↑ Nuwayhid ZB, Aronoff DM, Mulla ZD (2007). "Blunt trauma as a risk factor for group A streptococcal necrotizing fasciitis". Ann Epidemiol. 17 (11): 878–81. doi:10.1016/j.annepidem.2007.05.011. PMC 4029051. PMID 17697787.
- ↑ Aldape MJ, Bryant AE, Stevens DL (2006). "Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment". Clin. Infect. Dis. 43 (11): 1436–46. doi:10.1086/508866. PMID 17083018.
- ↑ Foroulis CN, Gerogianni I, Kouritas VK, Karestsi E, Klapsa D, Gourgoulianis K, Petinaki E (2007). "Direct detection of Clostridium sordellii in pleural fluid of a patient with pneumonic empyema by a broad-range 16S rRNA PCR". Scand. J. Infect. Dis. 39 (6–7): 617–9. doi:10.1080/00365540601105798. PMID 17577829.
- ↑ Spera RV, Kaplan MH, Allen SL (1992). "Clostridium sordellii bacteremia: case report and review". Clin. Infect. Dis. 15 (6): 950–4. PMID 1457666.