Materiały źródłowe

• #1 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459345/

  Toxic shock syndrome (TSS) is an acute-onset illness characterized by fever, hypotension, sunburn-like rash, and end-organ damage. […] Early recognition and antibiotic administration are key to improving patient outcomes and reducing mortality. […] There is no specific lab test to identify TSS. A complete blood count (CBC) may show leukocytosis or leukopenia. […] Evaluation of multisystem organ involvement including CBC, CMP, CK, and coagulation studies should be drawn to evaluate for the clinical criteria of TSS. […] Patients should receive aggressive intravenous (IV) fluid hydration with crystalloids. […] Broad-spectrum antibiotics should be administered for those with an unidentified organism, if possible after blood cultures and cultures from the suspected source have been drawn.

• #2 Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

  Toxic shock syndrome (TSS) is a rare but serious condition caused by certain strains of bacteria. […] Knowing the signs of TSS and seeking prompt treatment results in the best outcomes. […] The symptoms of TSS happen suddenly and worsen quickly. However, most people recover if TSS is diagnosed and treated quickly. […] Some of the ways healthcare providers diagnose toxic shock syndrome are: Blood or urine tests to determine what type of bacteria or virus is present. […] Examine your vagina. […] Obtain tissue cultures from your vagina, cervix or throat so they can be analyzed for the presence of Staphylococcus or Streptococcus bacteria. […] Obtain tissue from the wound or infection (for non-menstrual TSS). […] Treatment typically involves hospitalization due to the potentially life-threatening nature of toxic shock syndrome.

• #3 Toxic shock syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/toxic-shock-syndrome

  Toxic shock syndrome is a serious and potentially life-threatening disease that involves fever, shock, and problems with several body organs. […] No single test can diagnose toxic shock syndrome. […] The health care provider will look for the following factors: Fever, Low blood pressure, Rash that peels after 1 to 2 weeks, Problems with the function of at least 3 organs. […] In some cases, blood cultures may be positive for growth of S aureus or Streptococcus pyogenes.

• #4 Early suspicion of toxic shock syndrome

  https://emcrit.org/pulmcrit/early-suspicion-of-toxic-shock-syndrome/

  Toxigenic symptoms may be less prominent compared to staph TSS. […] The degree of illness is typically out of proportion to the focus of infection. […] Poor response to standard treatments for sepsis can also suggest TSS. […] Laboratory studies are generally nonspecific in TSS. […] Complex diagnostic criteria exist for both staph and strep TSS, but they are unhelpful and potentially dangerous. […] Treatment should never be withheld because a patient doesn’t meet formal diagnostic criteria. […] Diagnosing TSS is challenging, and in some cases it is impossible to ever reach a definitive diagnosis. […] It is essential to treat TSS as early as possible. […] If there is any suspicion of TSS, it is reasonable to initiate toxin-suppressive antibiotics. […] Unfortunately, TSS may manifest differently in different patients.

• #5 HOME – TSSIS

  https://www.tssis.com/

  TSS is a very rare but very serious illness and most Doctors will never see a case of TSS during their medical careers. […] However, the illness can develop rapidly in anyone, making them feel severely ill very quickly. It can be treated effectively with early diagnosis, so it is therefore important to be able to recognise the symptoms quickly. […] Regrettably, our medical advisory panel cannot advise on undiagnosed illnesses or personal cases. If you have questions regarding toxic shock syndrome relating to individual circumstances, we would encourage you to consult with an appropriate health professional.

• #6 Early suspicion of toxic shock syndrome

  https://emcrit.org/pulmcrit/early-suspicion-of-toxic-shock-syndrome/

  Toxic shock syndrome (TSS) is critical to recognize because it can be rapidly lethal and yet is usually treatable. […] Most cases of TSS are diagnosed late. […] A clear understanding of TSS can facilitate early diagnosis. […] Given that the severity of his septic shock seemed out of proportion to his cellulitis, he was treated emperically for TSS with clindamycin and intravenous immunoglobulin (IVIG). […] Staph TSS is usually diagnosed late, because nobody expects a young healthy person to have septic shock. […] It is possible that an elevated shock index could be an early sign of hemodynamic instability, particularly if this is refractory to volume resuscitation. […] Strep TSS may result from an occult focus of infection (e.g., small abscess). […] It may be impossible to distinguish these diseases initially, and therefore in practice it is often safest to treat empirically for both of them simultaneously.

• #7 Toxic Shock Syndrome – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/toxic-shock-syndrome-diagnosis/

  Toxic Shock Syndrome (TSS) is a severe systemic illness characterized by a constellation of symptoms: shock, fever, erythematous or desquamating rash, GI symptoms, and CNS disturbances. It is often mistaken for viral illness or septic shock. […] If unidentified and untreated, TSS can have a high mortality (up to 50%!). […] The commonly referenced CDC diagnostic criteria were designed for epidemiologic research, to define retrospectively with a high degree of specificity whether patients fit the typical description of Toxic Shock Syndrome along the entire course of their illness: […] A patient does not need to fully meet these criteria for treatment to be indicated and life-saving. […] In the ED, our priority should be early consideration, with a presumptive diagnosis made based on a clinical gestalt of how well the patient fits these typical features, and the likelihood of alternate diagnoses.

• #8 Toxic Shock Syndrome – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/toxic-shock-syndrome-diagnosis/

  Avoiding irreversible organ failure depends upon early initiation of treatment, before the patient meets the CDC Case Definition. […] The ultimate diagnosis of TSS may be retrospectively applied according to the CDC case definition later in the clinical course, although early treatment may halt the pathological process resulting in “Aborted TSS.”

• #9 Toxic Shock Syndrome: Keys in Diagnosis and Management – emDocs

  https://www.emdocs.net/toxic-shock-syndrome-keys-in-diagnosis-and-management/

  Toxic shock syndrome (TSS) is an acute, toxin-mediated sickness with fever, hypotension, multi-organ dysfunction, and a diffuse rash with desquamation. TSS is treatable if diagnosed, but if missed, it can be rapidly lethal. The annual incidence is between 1.5-11 per 100,000 people. […] The CDC recommends using several criteria for diagnosis of TSS, though streptococcal and staphylococcal TSS differ in several components. Based on these criteria, you can see that official diagnosis in the ED is difficult. Patients may not exhibit the necessary signs or symptoms to meet the complete CDC criteria for diagnosis. In fact, these criteria were initially designed for research, not clinical use, and most of the criteria develop later in the disease course. […] If the disease is likely but does not meet official CDC criteria, treatment for TSS is recommended, while focusing on resuscitation and broad-spectrum antibiotics. Remember, this disease is deadly. The key in management is to suspect the disease based on the clinical situation, rather than meeting all CDC criteria for diagnosis.

• #10 Toxic shock syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/329

  Toxic shock syndrome (TSS) is an exotoxin-mediated illness caused by bacterial infection, most commonly group A streptococcus or Staphylococcus aureus. […] Early diagnosis and treatment is essential. […] Key diagnostic factors include severe diffuse or localised pain in an extremity, fever, localised swelling or erythema, hypotension, and diffuse, scarlatina-like erythematous rash. […] Other diagnostic factors include acute mental status changes, influenza-like symptoms, muscular tenderness and weakness, gastrointestinal symptoms, features of myocarditis, endophthalmitis, and hypothermia. […] 1st investigations to order include microscopy and culture (blood, wound, fluid, tissue), FBC, coagulation profile, serum urea and creatinine, urinalysis, LFTs, creatine kinase (CK), serum calcium, serum sodium, serum phosphorus, serum albumin, and serum lactic acid. […] Investigations to consider include Staphylococcus aureus antibody testing and chest x-ray. […] Emerging tests include serotyping.

• #11 Toxic shock syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/329

  Toxic shock syndrome (TSS) is an exotoxin-mediated illness caused by bacterial infection, most commonly group A streptococcus or Staphylococcus aureus. […] Early diagnosis and treatment is essential. […] Key diagnostic factors include severe diffuse or localized pain in an extremity, fever, localized swelling or erythema, hypotension, and diffuse, scarlatina-like erythematous rash. […] Other diagnostic factors include acute mental status changes, influenza-like symptoms, muscular tenderness and weakness, gastrointestinal symptoms, features of myocarditis, endophthalmitis, and hypothermia. […] 1st tests to order include microscopy and culture (blood, wound, fluid, tissue), CBC, coagulation profile, serum BUN and creatinine, urinalysis, LFTs, creatine kinase (CK), serum calcium, serum sodium, serum phosphorus, serum albumin, and serum lactic acid. […] Tests to consider include Staphylococcus aureus antibody testing and chest x-ray. […] Emerging tests include serotyping.

• #12 Toxic shock syndrome – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/toxic-shock-syndrome/

  The symptoms of staphylococcal toxic shock syndrome (staph TSS) are the following: fever, chills, nausea, vomiting, diarrhea, and confusion. […] The physical findings for staph TSS are fever, tachycardia, hypotension, sun burn type rash (90%), and altered mental status. […] Staph TSS is most commonly associated with tampon use during menstruation. Thus, the source of infection is the vaginal vault. […] For staph TSS, the greatest predisposing factor is tampon use. […] In both staph and strep TSS, the white blood cell count is modestly elevated and the differential count shows increased bands, metamyelocytes, and myelocytes. […] Blood cultures are rarely positive in staph TSS, but are positive in 60% of patients with strep TSS. […] Imaging studies are rarely necessary in patients with staph TSS.

• #13 Orphanet: Streptococcal toxic-shock syndrome

  https://www.orpha.net/en/disease/detail/99918

  Streptococcal TSS is caused by an infection with Streptococcus pyogenes, also known as group A streptococcus (GAS), and is usually associated with skin infections, child birth, and surgeries. […] Clinical symptoms along with laboratory analysis are the basis for diagnosis of streptococcal TSS. Patients with fever, multisystem organ failure and shock are tested for GAS in their blood or a normally sterile site (e.g. cerebrospinal, pleural or peritoneal fluid) and those who test positive are given a diagnosis of streptococcal TSS. […] Bacteremia is present in most patients with streptococcal TSS (approximately 60%) which is not the case in staphylococcal TSS where it is seen in approximately 5% of cases.

• #14 Toxic shock syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/diagnosis-treatment/drc-20355390

  There’s no one test for toxic shock syndrome. You may need to provide blood and urine samples to test for the presence of a staph or strep infection. Your vagina, cervix and throat may be swabbed for samples to be analyzed in a lab. […] Because toxic shock syndrome can affect multiple organs, your doctor may order other tests, such as a CT scan, lumbar puncture or chest X-ray, to assess the extent of your illness.

• #15 Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

  Toxic shock syndrome (TSS) is a rare but serious condition caused by certain strains of bacteria. […] Knowing the signs of TSS and seeking prompt treatment results in the best outcomes. […] The symptoms of TSS happen suddenly and worsen quickly. However, most people recover if TSS is diagnosed and treated quickly. […] Some of the ways healthcare providers diagnose toxic shock syndrome are: Blood or urine tests to determine what type of bacteria or virus is present. […] Examine your vagina. […] Obtain tissue cultures from your vagina, cervix or throat so they can be analyzed for the presence of Staphylococcus or Streptococcus bacteria. […] Obtain tissue from the wound or infection (for non-menstrual TSS). […] Treatment typically involves hospitalization due to the potentially life-threatening nature of toxic shock syndrome.

• #16 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459345/

  Toxic shock syndrome (TSS) is an acute-onset illness characterized by fever, hypotension, sunburn-like rash, and end-organ damage. […] Early recognition and antibiotic administration are key to improving patient outcomes and reducing mortality. […] There is no specific lab test to identify TSS. A complete blood count (CBC) may show leukocytosis or leukopenia. […] Evaluation of multisystem organ involvement including CBC, CMP, CK, and coagulation studies should be drawn to evaluate for the clinical criteria of TSS. […] Patients should receive aggressive intravenous (IV) fluid hydration with crystalloids. […] Broad-spectrum antibiotics should be administered for those with an unidentified organism, if possible after blood cultures and cultures from the suspected source have been drawn.

• #17 Toxic Shock Syndrome Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/169177-workup

  CBC count with differential should be performed to determine the following: […] Urinalysis should be performed to determine the following: […] Prolonged prothrombin and activated partial thromboplastin times should be obtained. […] Serum biochemistry to determine the following: […] Blood cultures to determine the following: […] Gram stain and cultures to determine the following: […] Common laboratory abnormalities in patients with streptococcal TSS include the following: […] The case definition of streptococcal toxic shock syndrome (TSS) involves (1) the isolation of group A Streptococcus (GAS) from either a sterile body site or a nonsterile body site and (2) a determination the clinical severity based on whether hypotension is present and the presence/absence of the following clinical and laboratory abnormalities:

• #18 Toxic Shock Syndrome – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/toxic-shock-syndrome-a-to-z

  Diagnosing toxic shock syndrome is crucial as a patient may be too ill to answer questions, necessitating a family member or friend to inform the doctor about the patient’s medical history and symptoms. […] To help establish the diagnosis, the doctor will thoroughly examine you, including your vital signs (blood pressure, heart rate, temperature), and your heart, lungs, abdomen, skin, muscles, and neurological system. Your doctor also will order the following tests to determine if the problem is caused by toxic shock syndrome or another process, and to evaluate the severity of your illness: blood tests to measure levels of white blood cells, red blood cells, and platelets, blood tests to evaluate how well the blood clots, blood chemistry tests to measure kidney function (blood urea nitrogen, or BUN, and creatinine) and liver function (liver enzymes and total bilirubin), urinalysis, tests to check blood samples, wound discharge, or other body fluids for the presence of group A streptococcal or staphylococcal bacteria. […] In addition, people with severe breathing difficulties will need a chest x-ray and a test for blood oxygen content.

• #19 HEALTH PROFESSIONALS – TSSIS

  https://www.tssis.com/healthcare_professionals/

  Staphylococcal toxic shock syndrome (TSS) is a rare, life-threatening systemic bacterial intoxication. […] The diagnosis rests exclusively on clinical grounds and, while often readily established, it must first be considered. […] Accordingly, health professionals should be familiar with the manifestations of TSS, and should vigilantly consider the diagnosis in appropriate clinical settings. […] The differential diagnosis of the patient acutely ill with fever, rash and hypotension is extensive. […] A careful history with attention to past health, possible infectious exposures, travel, vocation, hobbies, vaccination status, menstrual status and medication usage often narrows the diagnostic possibilities considerably. […] Laboratory findings consistent with TSS include leucocytosis, elevated prothrombin time, hypoalbuminemia, hypocalcaemia, and pyuria. Each is present in greater than 70 percent of patients. […] Consider the possibility of mild systemic staphylococcal intoxication in young women reporting substantial or recurrent perimenstrual flu-like illness, particularly if that illness is associated with erythroderma or desquamation.

• #20 Toxic Shock Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/toxic-shock-syndrome-pro

  Blood cultures are positive in 5-15% of cases of TSS and in approximately 50% of STSS. […] FBC often shows leukocytosis and low platelets. […] UEs may show raised urea and creatinine, electrolyte disturbance and hypocalcaemia. […] CK and LFTs may be elevated. […] Urinalysis may show microscopic haematuria/myoglobinuria. […] Any wounds should be swabbed for culture. […] Throat swab/others as per clinical suspicion of focus of infection. […] CXR may be useful if there is suspected pneumonic focus. […] Early diagnosis and rapid intervention are the key to arresting the cascade of inflammation that leads to rapid deterioration. […] Any persisting focus of infection, such as abscess, wound pack, wound slough or tampon, should be removed immediately, with surgical assistance if necessary.

• #21 Toxic shock syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/diagnosis-treatment/drc-20355390

  There’s no one test for toxic shock syndrome. You may need to provide blood and urine samples to test for the presence of a staph or strep infection. Your vagina, cervix and throat may be swabbed for samples to be analyzed in a lab. […] Because toxic shock syndrome can affect multiple organs, your doctor may order other tests, such as a CT scan, lumbar puncture or chest X-ray, to assess the extent of your illness.

• #22 Toxic Shock Syndrome (TSS) – Basics & Causes

  https://www.webmd.com/women/understanding-toxic-shock-syndrome-basics

  Doctors test for TSS in several ways: […] Test blood and urine samples for a staph or strep infection. […] Take a swab of your vagina, cervix, or throat. […] Take a swab from an infected wound. […] Test your blood for cell counts and enzyme levels that show how well your organs are working. […] Measure how quickly your blood clots. […] Use a CT scan, spinal tap, or chest X-ray to look for other signs TSS is affecting your organs.

• #23 Toxic shock syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/toxic-shock-syndrome?lang=us

  In general, cross-sectional imaging is useful to assess for the source of infection. MRI is much more sensitive than CT when diagnosing soft tissue infections but its lack of specificity may be a drawback, increasing risk of false-positives. […] Point-of-care ultrasound (POCUS) can provide added value at the bedside in the ICU. […] Empiric antibiotics initially must include an antimicrobial agent that is known to inhibit superantigen synthesis, e.g. clindamycin or linezolid. […] Intravenous immunoglobulins (IVIG) are important as they bind to, and neutralise, the superantigens, thus preventing a potential cytokine storm.

• #24 Toxic Shock Syndrome (TSS) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/toxic-shock-syndrome

  Is there a specific test to diagnose TSS? […] There is no one test, but its critical to rule out other illness that look like TSS. Diagnostic tests may include: […] Blood cultures […] Blood tests […] Urine tests […] Wound cultures if indicated […] Lumbar puncture (spinal tap)

• #25 Toxic shock syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Toxic_shock_syndrome

  Diagnostic method Based on symptoms. […] Diagnosis is typically based on symptoms. […] For staphylococcal toxic shock syndrome, the diagnosis is based upon CDC criteria defined in 2011, as follows: Body temperature 38.9 C (102.0 F), Systolic blood pressure 90 mmHg, Diffuse macular erythroderma, Desquamation (especially of the palms and soles) 12 weeks after onset, Involvement of three or more organ systems. […] Cases are classified as confirmed or probable as follows: Confirmed: All six of the criteria above are met (unless the patient dies before desquamation can occur), Probable: Five of the six criteria above are met.

• #26 Toxic Shock Syndrome Differential Diagnoses

  https://emedicine.medscape.com/article/169177-differential

  A diagnosis of staphylococcal toxic shock syndrome (TSS) is based on the criteria below. […] The diagnosis is considered confirmed if the laboratory criteria are met and all five of the clinical criteria described above are present. […] The diagnosis is considered probable if the laboratory criteria are met and four of five clinical criteria are met. […] A diagnosis of streptococcal toxic shock syndrome (TSS) is based on the following criteria. […] The diagnosis of streptococcal TSS is definite when criteria A1, B1, and B2 are met. […] The diagnosis of streptococcal TSS is probable when criteria A2, B1, and B2 are met.

• #27 Toxic Shock Syndrome (Other Than Streptococcal) (TSS) 2011 Case Definition | CDC

  https://ndc.services.cdc.gov/case-definitions/toxic-shock-syndrome-2011/

  An illness with the following clinical manifestations: […] Laboratory Criteria For Diagnosis […] A case which meets the laboratory criteria and in which four of the five clinical criteria described above are present […] A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs.

• #28 Toxic Shock Syndrome Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/169177-workup

  A definite case of TSS is defined as isolation of GAS from a sterile site and hypotension plus two or more of the clinical and laboratory abnormalities. […] A probable case of TSS is defined as isolation of GAS from a nonsterile body site and hypotension plus two or more of the clinical and laboratory abnormalities. […] Imaging studies include the following:

• #29 Clinical Guidance for Streptococcal Toxic Shock Syndrome | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/streptococcal-toxic-shock-syndrome.html

  Diagnosing STSS can be difficult and patients are often misdiagnosed. […] Diagnosis of STSS is made based on the Council of State and Territorial Epidemiologists (CSTE) 2010 case definition. […] The case definition requires hypotension and multi-organ involvement, as well as isolation of group A strep bacteria. […] The differential diagnosis of patients in the early stages of STSS is broad. The differential diagnosis can include other viral or bacterial infections (such as staphylococcal toxic shock). Patients are often misdiagnosed.

• #30 Toxic Shock Syndrome (TSS) – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/toxic-shock-syndrome-tss

  Diagnosis of toxic shock syndrome (TSS) is made clinically and by isolating the organism from blood cultures (for Streptococcus) or from the local site. […] Specimens for culture should be taken from any lesions, the nose (for staphylococci), throat (for streptococci), vagina (for both), and blood. […] MRI or CT of soft tissue is helpful in localizing sites of infection. […] Continuous monitoring of renal, hepatic, bone marrow, and cardiopulmonary function is necessary. […] TSS resembles Kawasaki disease, but Kawasaki disease usually occurs in children 5 years of age and does not cause shock, azotemia, or thrombocytopenia; the rash is maculopapular. […] Other disorders to be considered are scarlet fever, Reye syndrome, staphylococcal scalded skin syndrome, meningococcemia, Rocky Mountain spotted fever, leptospirosis, and viral exanthematous diseases. These disorders are ruled out by specific clinical differences, cultures, and serologic tests.

• #31 Toxic Shock Syndrome – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/toxic-shock-syndrome-3/

  Toxic shock syndrome (TSS) is an acute, potentially life-threatening, condition characterized by fever, rash, hypotension, and multiorgan damage. […] Diagnosis is considered definite if all six criteria are met, and probable if five are met. […] Diagnosis is considered definite if conditions 1a and 2 (a and b) are met, and probable if conditions 1b and 2 (a and b) are fulfilled and no other cause is found. […] Laboratory abnormalities reveal organ dysfunction as described in the clinical case definitions. Positive cultures are found in 60% of streptococcal TSS cases and less than 5% of staphylococcal ones. […] A skin biopsy is usually not necessary, as the diagnosis of TSS is based on clinical evidence. […] The differential diagnosis of TSS includes streptococcal scarlet fever, staphylococcal scalded skin syndrome, and Kawasaki syndrome (all of which lack signs of septic shock).

• #32 Toxic Shock Syndrome (TSS) – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/toxic-shock-syndrome-tss

  Diagnosis of toxic shock syndrome (TSS) is made clinically and by isolating the organism from blood cultures (for Streptococcus) or from the local site. […] Specimens for culture should be taken from any lesions, the nose (for staphylococci), throat (for streptococci), vagina (for both), and blood. […] MRI or CT of soft tissue is helpful in localizing sites of infection. […] Continuous monitoring of renal, hepatic, bone marrow, and cardiopulmonary function is necessary. […] TSS resembles Kawasaki disease, but Kawasaki disease usually occurs in children 5 years of age and does not cause shock, azotemia, or thrombocytopenia; the rash is maculopapular. […] Other disorders to be considered are scarlet fever, Reye syndrome, staphylococcal scalded skin syndrome, meningococcemia, Rocky Mountain spotted fever, leptospirosis, and viral exanthematous diseases. These disorders are ruled out by specific clinical differences, cultures, and serologic tests.

• #33 Early suspicion of toxic shock syndrome

  https://emcrit.org/pulmcrit/early-suspicion-of-toxic-shock-syndrome/

  TSS should be considered in many situations, especially the following: Systemic illness plus a diffuse blanchable erythematous rash. […] Septic shock due to proven or probable Group A streptococcal infection (e.g., cellulitis, necrotizing fasciitis), with sepsis severity out of proportion to the infectious source.

• #34 Early suspicion of toxic shock syndrome

  https://emcrit.org/pulmcrit/early-suspicion-of-toxic-shock-syndrome/

  Toxic shock syndrome (TSS) is critical to recognize because it can be rapidly lethal and yet is usually treatable. […] Most cases of TSS are diagnosed late. […] A clear understanding of TSS can facilitate early diagnosis. […] Given that the severity of his septic shock seemed out of proportion to his cellulitis, he was treated emperically for TSS with clindamycin and intravenous immunoglobulin (IVIG). […] Staph TSS is usually diagnosed late, because nobody expects a young healthy person to have septic shock. […] It is possible that an elevated shock index could be an early sign of hemodynamic instability, particularly if this is refractory to volume resuscitation. […] Strep TSS may result from an occult focus of infection (e.g., small abscess). […] It may be impossible to distinguish these diseases initially, and therefore in practice it is often safest to treat empirically for both of them simultaneously.

• #35 Toxic shock syndrome: broadening the differential diagnosis. | American Board of Family Medicine

  https://www.jabfm.org/content/14/2/131

  BACKGROUND Toxic shock syndrome is a rare but potentially fatal toxin-mediated febrile illness. […] Serious morbidity and mortality can occur if this syndrome is not promptly recognized. […] A case of nonmenstrual toxic shock syndrome associated with an intrauterine device and a review of the definition, cause, diagnostic criteria, and management are reported. […] Toxic shock syndrome can mimic many common diseases. Because it can be associated with a number of nonmenstrual-related conditions, patients with unexplained fever and rash and a toxic condition out of proportion to local findings should have the diagnosis of toxic shock syndrome in their differential diagnosis. Early recognition and aggressive management can decrease the overall morbidity and mortality.

• #36 Toxic Shock Syndrome – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/toxic-shock-syndrome-a-to-z

  Diagnosing toxic shock syndrome is crucial as a patient may be too ill to answer questions, necessitating a family member or friend to inform the doctor about the patient’s medical history and symptoms. […] To help establish the diagnosis, the doctor will thoroughly examine you, including your vital signs (blood pressure, heart rate, temperature), and your heart, lungs, abdomen, skin, muscles, and neurological system. Your doctor also will order the following tests to determine if the problem is caused by toxic shock syndrome or another process, and to evaluate the severity of your illness: blood tests to measure levels of white blood cells, red blood cells, and platelets, blood tests to evaluate how well the blood clots, blood chemistry tests to measure kidney function (blood urea nitrogen, or BUN, and creatinine) and liver function (liver enzymes and total bilirubin), urinalysis, tests to check blood samples, wound discharge, or other body fluids for the presence of group A streptococcal or staphylococcal bacteria. […] In addition, people with severe breathing difficulties will need a chest x-ray and a test for blood oxygen content.

• #37 Diagnosing and treating toxic shock syndrome

  https://www.mymed.com/diseases-conditions/toxic-shock-syndrome-tss/diagnosing-and-treating-toxic-shock-syndrome

  Diagnostic procedures and treatment to be implemented must happen quickly to prevent severe complications. […] A doctor will then conduct a physical exam to assess the nature of symptoms. Blood pressure will be taken and if very low, and accompanied by other signs of multiorgan problems (kidneys, liver, lungs, skin or blood), a doctor will likely suspect TSS. […] The doctor will then wish to have blood and urine samples analysed (in a laboratory) in order to determine the presence of bacteria and also to identify which type it is. […] If signs of distress affecting multiple organs in the body are evident, a doctor may recommend other testing procedures in order to determine the extent of damage caused. These can include a CT scan (computerised tomography), chest X-ray or lumbar puncture.

• #38

  https://journals.lww.com/pec-online/fulltext/2020/03000/toxic_shock_syndrome__still_a_timely_diagnosis.23.aspx

  Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. […] Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. […] Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.

• #39 Toxic Shock Syndrome (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/tss.html

  If doctors think someone has toxic shock syndrome, they’ll start intravenous (IV) fluids and antibiotics as soon as possible, even before they’re sure the person has TSS. […] To confirm a diagnosis, doctors take a sample from the likely site of the infection, such as the skin, nose, or vagina, to check for the bacteria. They also may take and test a blood sample. Other blood tests can help doctors: see how organs like the kidneys are working, check for other diseases that might be causing the symptoms.

• #40 Toxic shock syndrome – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/toxic-shock-syndrome/

  TSS is a clinical diagnosis and treatment should be initiated as soon as TSS is suspected. […] Obtain blood cultures and initiate empiric antibiotic therapy for TSS as soon as TSS is suspected. […] Initiate empiric antibiotic therapy for TSS as soon as TSS is suspected; do not wait for the results of laboratory studies. […] Blood cultures: Obtain blood cultures in all patients, preferably before administering empiric antibiotics. […] Blood cultures are typically negative in staphylococcal TSS. […] TSST-1 assay of S. aureus culture isolate: Consider in patients with suspected staphylococcal TSS. […] A positive TSST-1 assay supports a diagnosis of staphylococcal TSS. […] TSST-1 antibody titers: Consider in patients with menstrual TSS or recurrent staphylococcal TSS. […] Undetectable or low antibody titers indicate an increased risk of recurrent TSS.

• #41 Streptococcal toxic shock syndrome in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0438-y

  The streptococcal toxic shock syndrome is a severe complication associated with invasive infections by group A streptococci. […] Early recognition and multidisciplinary management are key to the care of patients with streptococcal toxic shock syndrome, with intensive and appropriate intensive support of failing organs, rapid diagnosis of infectious source(s), and surgical management. […] To establish the diagnosis of STSS, GAS need to be isolated from a sterile site. […] Increased creatinine levels at the time of admission are suggestive of STSS due to GAS, and more frequently observed than in other cases of classical septic shock. […] The clinical criteria defined by the CDC are based on signs of shock, organ dysfunction, and skin involvement. […] The definition of probable and confirmed cases (CDC criteria) are the following: A probable case is a case that meets the clinical case definition in the absence of another identified etiology for the illness, and with isolation of GAS from a non-sterile site. A confirmed case is a case that meets the clinical case definition and with isolation of group A streptococcus from a normally sterile site (e.g., blood, cerebrospinal, synovial, pleural or pericardial fluid).

• #42 Streptococcal toxic shock syndrome in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0438-y

  The management of STSS requires a multidisciplinary team involving intensivists, specialists in infectious diseases, microbiologists, and surgeons. Early identification of the disease, as well as rapid treatment, is key to minimize both morbidity and mortality in this deadly disease. […] Antibiotic therapy should be given rapidly, associating high doses of parenteral beta-lactams plus clindamycin for its anti-toxin effect. […] The addition of clindamycin to penicillin may improve patient outcomes and reduce mortality. […] The use of IVIG in STSS cannot be routinely recommended and should be discussed on a case-by-case basis.

• #43 Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

  First, your healthcare provider will remove any tampons or contraceptive devices from your vagina if that is suspected to be the cause. […] Then, you’ll be given intravenous (IV) fluids and possibly medications to raise your blood pressure if it’s low. […] The standard treatment for Staphylococcus or Streptococcus infection involves antibiotics through an IV. […] Toxic shock syndrome is serious and life-threatening. Symptoms can progress quickly, and immediate treatment is necessary. […] No, toxic shock syndrome won’t go away on its own. Prompt treatment is necessary to avoid potentially deadly complications. […] You can take steps to lower your risk for toxic shock syndrome. […] Some of these include: Use sanitary pads instead of tampons during menstrual periods or use pads at night.

• #44 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459345/

  Toxic shock syndrome (TSS) is an acute-onset illness characterized by fever, hypotension, sunburn-like rash, and end-organ damage. […] Early recognition and antibiotic administration are key to improving patient outcomes and reducing mortality. […] There is no specific lab test to identify TSS. A complete blood count (CBC) may show leukocytosis or leukopenia. […] Evaluation of multisystem organ involvement including CBC, CMP, CK, and coagulation studies should be drawn to evaluate for the clinical criteria of TSS. […] Patients should receive aggressive intravenous (IV) fluid hydration with crystalloids. […] Broad-spectrum antibiotics should be administered for those with an unidentified organism, if possible after blood cultures and cultures from the suspected source have been drawn.

• #45 Toxic Shock Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/toxic-shock-syndrome-pro

  Aggressive haemodynamic resuscitation, preferably with central fluid volume monitoring and regular electrolyte testing, is crucial. […] Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus-prevalent areas) along with either clindamycin or linezolid. […] Steroids may play a role in improving survival. […] Mortality rate for TSS is around 5-15%. […] A fatality rate of up to 64% has been noted in cases of STSS in the UK. […] Recurrence of TSS is found in 30-40% of cases.

• #46 Diagnosing and treating toxic shock syndrome

  https://www.mymed.com/diseases-conditions/toxic-shock-syndrome-tss/diagnosing-and-treating-toxic-shock-syndrome

  Once a doctor determines TSS is the cause of symptoms in a patient, treatment will likely be administered in hospital (usually in the ICU / intensive-care unit). […] Once hospitalised, medical professionals will carefully monitor the patients signs and symptoms and whether treatment implemented is working over the course of a few days (sometimes longer). […] Treatment for the majority of TSS cases (which may vary from one infection to another) will usually involve two or more of the following types of treatment: […] Once discharged from hospital, antibiotics may be prescribed to be taken for a further 6 to 8 weeks and frequent visits to an infectious diseases specialist may be required to monitor physical condition through physical examinations and blood tests.

• #47 Toxic Shock Syndrome | Sepsis Alliance

  https://www.sepsis.org/sepsisand/toxic-shock/

  Because the symptoms for TSS occur so quickly, its vital that they be recognized, and TSS diagnosed and treated as quickly as possible. Blood tests will be done to find out what type of bacteria caused the TSS. Other tests, such as swabs from parts of your body that could be infected, urine tests, CT scans, and lumbar punctures may also be done. […] The treatment for TSS is the same as for septic shock. If the cause of the infection is removable (tampon, wound packing, etc.), this will be done right away. The doctors will order intravenous (IV) fluids and antibiotics to start fighting the infection right away. Other treatments may include: […] Medications for blood pressure: If your blood pressure is too low, you might need medications to bring it back up. […] Dialysis: If your kidneys have stopped working, you may need dialysis until your kidneys can do their job again.

• #48 Toxic Shock Syndrome | Sepsis Alliance

  https://www.sepsis.org/sepsisand/toxic-shock/

  Oxygen: You may have an oxygen mask that delivers oxygen to help you breathe better. […] Ventilator: If you have trouble breathing, you may need intubation (a tube placed in your trachea) and a ventilator, or breathing machine. […] Surgery: If necessary, a surgeon will operate to remove infected or gangrenous tissue that is causing the TSS.

• #49 Toxic shock syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/toxic-shock-syndrome?lang=us

  In general, cross-sectional imaging is useful to assess for the source of infection. MRI is much more sensitive than CT when diagnosing soft tissue infections but its lack of specificity may be a drawback, increasing risk of false-positives. […] Point-of-care ultrasound (POCUS) can provide added value at the bedside in the ICU. […] Empiric antibiotics initially must include an antimicrobial agent that is known to inhibit superantigen synthesis, e.g. clindamycin or linezolid. […] Intravenous immunoglobulins (IVIG) are important as they bind to, and neutralise, the superantigens, thus preventing a potential cytokine storm.

• #50 Toxic Shock Syndrome – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/toxic-shock-syndrome-3/

  Diagnoses that can be distinguished by antibody titer include Rocky Mountain spotted fever, leptospirosis, and measles. […] Similarly, culture results can differentiate meningococcemia and gram-negative sepsis. […] A thorough search for any nidus of infection should be performed. Remove all foreign bodies, drain any abscesses, and surgically debride any wounds, even if they do not appear infected. […] Begin intravenous antibiotics to cover S. aureus (including MRSA, if indicated) and GAS, and tailor accordingly if culture results are positive. […] If no response from supportive care is seen after 6 hours, begin intravenous immunoglobulin (IVIG). […] Treatment remains the same in these patients, as successful therapy has been achieved with supportive care and IVIG.

• #51 Toxic Shock Syndrome (TSS) – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/toxic-shock-syndrome-tss

  Diagnosis of toxic shock syndrome (TSS) is made clinically and by isolating the organism from blood cultures (for Streptococcus) or from the local site. […] Specimens for culture should be taken from any lesions, the nose (for staphylococci), throat (for streptococci), vagina (for both), and blood. […] MRI or CT of soft tissue is helpful in localizing sites of infection. […] Continuous monitoring of renal, hepatic, bone marrow, and cardiopulmonary function is necessary. […] TSS resembles Kawasaki disease, but Kawasaki disease usually occurs in children 5 years of age and does not cause shock, azotemia, or thrombocytopenia; the rash is maculopapular. […] Other disorders to be considered are scarlet fever, Reye syndrome, staphylococcal scalded skin syndrome, meningococcemia, Rocky Mountain spotted fever, leptospirosis, and viral exanthematous diseases. These disorders are ruled out by specific clinical differences, cultures, and serologic tests.

• #52 Toxic Shock Syndrome – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-gram-positive-bacteria/toxic-shock-syndrome

  Doctors diagnose toxic shock syndrome by doing a physical examination and by culturing and identifying the bacteria. […] The diagnosis of toxic shock syndrome is usually based on the symptoms and results of a physical examination and routine blood tests. […] Samples of blood and infected tissue are also sent to a laboratory where bacteria can be grown (cultured). […] Magnetic resonance imaging (MRI) or computed tomography (CT) may be done to locate sites of infection. […] Blood tests are done regularly to monitor how well organs are functioning.

• #53 Toxic Shock Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/toxic-shock-syndrome-pro

  Aggressive haemodynamic resuscitation, preferably with central fluid volume monitoring and regular electrolyte testing, is crucial. […] Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus-prevalent areas) along with either clindamycin or linezolid. […] Steroids may play a role in improving survival. […] Mortality rate for TSS is around 5-15%. […] A fatality rate of up to 64% has been noted in cases of STSS in the UK. […] Recurrence of TSS is found in 30-40% of cases.

• #54 Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

  Toxic shock syndrome is more likely to recur in people who’ve already had it. […] Contact your healthcare provider if you have signs of toxic shock syndrome, especially if you use tampons, have a skin wound or recently had surgery. […] TSS requires prompt treatment with antibiotics, fluids and medication for the best outcomes.

• #55 Toxic Shock Syndrome

  https://www.edana.org/how-we-take-action/product-safety/toxic-shock-syndrome

  Toxic Shock Syndrome is a rare but serious illness which can be fatal. It can be treated successfully if recognised quickly. […] It is important to understand the signs and symptoms of TSS. If you suspect that you or someone you know might have TSS you must seek immediate medical attention. […] With early diagnosis, toxic shock syndrome can be successfully treated. […] It is important to remember that if TSS is diagnosed and treated early, there is a good chance of recovery. […] In the unlikely event that you have these symptoms during your period, remove (and keep for doctors to test) your tampon and consult your doctor immediately, indicating that you have been using a tampon. […] TSS can reoccur. If you have previously been diagnosed with TSS you should not use tampons.

• #56 Diagnosing and treating toxic shock syndrome

  https://www.mymed.com/diseases-conditions/toxic-shock-syndrome-tss/diagnosing-and-treating-toxic-shock-syndrome

  Once a doctor determines TSS is the cause of symptoms in a patient, treatment will likely be administered in hospital (usually in the ICU / intensive-care unit). […] Once hospitalised, medical professionals will carefully monitor the patients signs and symptoms and whether treatment implemented is working over the course of a few days (sometimes longer). […] Treatment for the majority of TSS cases (which may vary from one infection to another) will usually involve two or more of the following types of treatment: […] Once discharged from hospital, antibiotics may be prescribed to be taken for a further 6 to 8 weeks and frequent visits to an infectious diseases specialist may be required to monitor physical condition through physical examinations and blood tests.

• #57 Women’s Health and Education Center (WHEC) – Toxic Shock Syndrome

  http://www.womenshealthsection.com/content/print.php3?title=gyn015&cat=3&lng=english

  There is no definitive test for TSS. […] The diagnosis is based on recognition of a constellation of signs and symptoms indicative of multi-organ involvement, which meets the Center for Disease and Prevention (CDC) criteria. […] Early detection and early treatment is the key to the success. […] Instructions and information about the recurrence TSS should be given to the patient upon discharge.

• #58 The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29366615/

  Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. […] This review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS. […] Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. […] Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.

• #59 Key Facts and Expert Guidance on Toxic Shock Syndrome · NVSCC

  https://nvscc.com/womens-health/understanding-toxic-shock-syndrome-key-facts-and-expert-guidance/

  Recognizing the symptoms of TSS is crucial for early detection and prompt medical intervention. […] Key signs to look for are sudden fever, low blood pressure, rash, vomiting, and diarrhea. While TSS is rare, the severity of the condition necessitates immediate medical attention to prevent complications. […] Prompt and appropriate medical treatment is crucial for individuals diagnosed with TSS. Some of the available treatment options may include hospitalization, intravenous antibiotics, and supportive care. Timely intervention significantly improves the prognosis, emphasizing the importance of seeking medical attention at the first signs of TSS. […] As a comprehensive healthcare facility, NVSCC emphasizes the importance of seeking expert guidance for any health concerns, including those related to Toxic Shock Syndrome. Our experienced medical professionals are dedicated to providing personalized care, accurate diagnosis, and effective treatment options. […] If you have concerns about TSS or any other health issue, dont hesitate to reach out to our expert team for guidance and support.

• #60 Toxic Shock Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/toxic-shock-syndrome-pro

  Aggressive haemodynamic resuscitation, preferably with central fluid volume monitoring and regular electrolyte testing, is crucial. […] Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus-prevalent areas) along with either clindamycin or linezolid. […] Steroids may play a role in improving survival. […] Mortality rate for TSS is around 5-15%. […] A fatality rate of up to 64% has been noted in cases of STSS in the UK. […] Recurrence of TSS is found in 30-40% of cases.

Zobacz więcej