Toxic shock syndrome physical examination
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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
Patients with toxic shock syndrome (TSS) usually appear with shock. Physical examination of patients with TSS is usually remarkable for hypotension, fever, and diffuse erythroderma.
The presence of desquamation on physical examination is highly suggestive of TSS.
Physical Examination
Appearance of the Patient
- TSS is presented by its shock symptoms.
- May be ill appearing in the early stages of the disease, progress to confusion and change in mental status by disease progress.
Vital Signs
- High grade Fever
- Hypotension: Systolic blood pressure of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of isotonic intravenous fluids
- Tachycardia: As a result of shock and hypotension
- Tachypnea: May be pressent as a result of pulmonary edema secondary to shock
- Tachycardia
- Tachypnea
Skin
- Diffuse pruritic maculopapular rash with palm and soles desquamation
- Erythroderma
- Superficial ulcerations
- Petechiae, vesicles, and bullae (specially in Streptococcal TSS)
- Skin desquamation (apears weeks after disease onset)
- Non-pitting edema
- Hair and nail loss[1][2][3].
HEENT
- Ophthalmoscopic exam may be abnormal with findings of conjunctival-scleral hemorrhage
- Hyperemia of oropharyngeal mucosa
Lungs
- Wet rales due to pulmonary edema complication
Heart
- Possibly a diastolic gallop (S3) due to pulmonary edema
Extremities
- Non-pitting edema (can develop as a result of increases in interstitial fluid)
Neuromuscular
- Patient is usually oriented but if the disease is not diagnosed, it can lead to altered mental status and confusion
- Hyporeflexia can be seen as a result of associated hypocalcemia/ hypophosphatemia
- Muscle cramps (as a result of hypocalcemia, a contributing complication of renal failure)
- Seizure
References
- ↑ "Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition - Judith Tintinalli, J. Stapczynski, O. John Ma, David M. Cline, Garth Meckler - Google Books".
- ↑ 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.
- ↑ 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.