Toxic Shock Syndrome

Toxic shock syndrome is an illness manifested by

1. Temperature greater than or equal to 38.8°C (102°F)

2. Diffuse macular erythroderma

3. Desquamation, particularly affecting the palms and soles, 1 to 2 weeks following onset of illness

4. Hypotension, as defined by a. Systolic blood pressure less than or equal to 90 mmHg for adults or less than the fifth percentile by age for those persons under 16 years of age b. Orthostatic decrease in diastolic blood pressure greater than or equal to 15 mmHg from lying to sitting c. Orthostatic syncope or dizziness

5. Multisystem involvement (three or more):

a. Gastrointestinal: vomiting or diarrhea at outset b. Muscular: Severe myalgia or creatinine phosphokinase twice the upper limit of normal c. Mucous membranes: Vaginal, oropharyngeal, or conjunctival hyperemia d. Renal: Blood urea nitrogen or creatinine twice the upper limit of normal or urinary sediment with pyuria in the absence of urinary tract infection e. Hepatic: Total bilirubin, alanine transferase, or aspartate transferase twice the upper limit of normal f. Hematologic: Platelets less than 100,000/pL

g. Central nervous system: Disorientation or alteration in consciousness without focal neurologic signs when fever and hypotension are absent

Although the diagnosis is primarily a clinical one, laboratory evaluation should include no rise in Rocky Mountain spotted fever, leptospirosis, or measles titers, if obtained, and negative blood, throat, and cerebrospinal fluid cultures. Blood cultures positive for Staphylococcus aureus is not inconsistent with the diagnosis of toxic shock syndrome.

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