References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | BACTERIUM. Staphylococcus aureus, Streptococcus pyogenes, et al - (toxins) Facultative gram- positive cocci |
| Reservoir | Human |
| Vector | None |
| Vehicle | Tampon (occasionally bandage, etc.) which includes toxinosis |
| Incubation Period | Unknown |
| Diagnostic Tests | Isolation of toxigenic Staphylococcus aureus Toxin assay available in specialized laboratories |
| Typical Adult Therapy | The role of topical (eg, vaginal) and systemic antistaphylococcal antibiotics is unclear |
| Typical Pediatric Therapy | As for adult |
| Clinical Hints | Fever (>38.9), hypotension (<90 mm Hg) and dermal erythema with desquamation; respiratory, cardiac or other disease present; most cases associated with ‘super absorbent’ tampon use or staphylococcal wound infection; case-fatality rate = 5% to 10%. |
| Synonyms | Streptococcal toxic shock syndrome, TSS |
CDC Case Definition for Surveillance: Toxic Shock Syndrome
A case requires an illness with the following clinical manifestations:
- Fever at least 38.9 C
- Diffuse macular erythema
- Desquamation 1 to 2 weeks after onset of illness (particularly of the palms and soles)
- Hypotension (less than 90 mm Hg for adults, or less than fifth percentile if below age 16 years or orthostatic hypotension)
- Multisystem involvement, consisting of three or more of the following: acute vomiting or diarrhea; myalgia and elevation of creatine phosphokinase levels; vaginal, oropharyngeal or conjunctival hyperemia; elevation of blood urea nitrogen or creatine to at least twice normal, or sterile pyuria; elevation of serum bilirubin or aminotransferase levels to at least twice normal; platelet count < 100,000/ cu mm; disorientation or alteration in consciousness unrelated to fever and hypotension
- Laboratory examination
- Negative cultures of blood, throat or cerebrospinal fluid (however, S. aureus may be present in blood)
- Negative tests for measles, leptospirosis or rickettsiosis
A probable case requires at least five of the above clinical findings. A confirmed case requires all six clinical findings (unless the patient dies before desquamation can occur).
Case Definition: Streptococcal Toxic Shock Syndrome
The case definition for Streptococcal toxic shock syndrome includes isolation of Streptococcus pyogenes in addition to:
- Hypotension as above
- Multiorgan involvement characterized by at least two of the following (defined above) • Renal impairment • Coagulopathy • Hepatic dysfunction • Acute respiratory distress syndrome • A generalized erythematous macular rash which may desquamate • Soft tissue necrosis (fasciitis, myositis, gangrene).