Toxic Shock Syndrome: The Challenge

Brit Long, MD, FACEP @long_brit

Disclosures

I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.

I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

The views expressed in this lecture do not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, Brooke Army Medical Center, or SAUSHEC EM Residency Program.

Objectives

1. Understand the causes and associations of toxic shock syndrome.

2. Describe the presentation of toxic shock syndrome.

3. Describe the diagnostic challenges of toxic shock and the faults of using the classic criteria.

4. Develop a plan for when to consider the diagnosis.

1. TSS - 2 major causes: Staph and Strep2. TSS is a difficult diagnosis –

• Severe, systemic illness with…• Diffuse, blanchable, red rash• Young patient with shock and viral illness• Focal infection with POOP• Severe group A strep infection• Vital signs OOP to degree of infection

3. Do not rely on classic criteria4. Suspect => Treat first, diagnose later

Staph Strep

Staph Strep

Staph

Strep

vs.

Strep50% of necrotizing

fasciitis cases caused by Strep are

associated with TSS

Labs…

Rash

Fever

Desquamation*

Hypotension

Multiorgan Failure

“Once the full range of symptoms become manifest, the diagnosis is usually straightforward. However, the patient may have developed irreversible organ failure by the time this occurs.”– Murray 2005

•Suspicion! • Severe, systemic

illness with…• Diffuse, blanchable, red

rash• Young patient with shock

and viral illness• Focal infection with

POOP• Group A strep infection• Vital signs OOP to degree

of infection

•If present •Source control•Antibiotics• IV resuscitation• ICU admission• IVIG?

1. TSS - 2 major causes: Staph and Strep2. TSS is a difficult diagnosis –

• Severe, systemic illness with…• Diffuse, blanchable, red rash• Young patient with shock and viral illness• Focal infection with POOP• Severe group A strep infection• Vital signs OOP to degree of infection

3. Do not rely on classic criteria4. Suspect => Treat first, diagnose later

@long_brit