Toxic shock syndrome caused by staphylococcus (without MRSA)
Last Updated: 2019-08-26
ICD11: -
Last Updated: 2019-08-26
Author(s): Anzengruber F., Navarini A.
ICD11: -
Todd et al. 1978.
Toxic-Shock-Syndrome, TSS.
Superantigen-producing staphylococcal disease with scarlatinous exanthema and reduced general condition. In the process, it can lead to shock and multiorgan failure.
At present, a constant incidence can be assumed.
As with all infections, the immune system is very important. Patients without TSST-1 neutralizing antibodies are far more likely to develop TSS than other patients.
The hypotension associated with TSS is shown by a prominent exanthema on the trunk, orthostatic dysfunction and a shock with multiorgan failure.
Fever: Temperature ≥ 38.9°C.
Blood pressure: Systolic blood pressure ≤ 90 mmHg (adults), less than 5th percentile for children under 16 years.
Multi-organ system (participation of ≥ 3 systems).
Muscular: Myalgia, ≥ 2-fold increased CK.
Mucous membrane: Vaginal, oropharyngeal and hyperemia of the subjunctive.
No other germ detection (except possibly Staphylococcus aureus, however the detection of S. aureus is not essential to make the diagnosis).
Negative serological test (antibodies are often only determined in special laboratories) for Rocky Mountain Spotted Fever, leptospirosis or measles.
Bacterial smears (where focus is suspected: neck, vagina, skin lesions, nasal atrium, groin). S. aureus can be isolated from the suspicious focus in 80-90% of cases, but serological detection is only possible in 5% of cases.
Blood count (anemia, leukocytosis with neutrophilia, thrombocytopenia), coagulation (consumption coagulopathy, prolonged prothrombin time and partial thromboplastin time), creatinine, Urea (renal insufficiency), transaminases, bilirubin (liver insufficiency), creatinine kinase (myalgia), electrolytes (hyponatremia, hypalbuminemia, hypocalcemia, hypophosphatemia),
Blood culture (pathogen detection), U status.
CNS symptoms (encephalopathy with disorientation, confusion, epileptic seizures, cerebral edema, headache, memory loss, poor concentration): Neurological consil and cerebrospinal puncture.
Breathing problems: Thoracic x-ray and, if necessary, internal consil.
Exclusion of a vaginal/intrauterine foreign body.
Vital parameter monitoring.
Women with M-STSS should no longer use tampons. Spirals for contraception should also be avoided.
Recurrences occur days to months after the initial manifestation, in patients who have not received sufficient antibiotic treatment, do not produce their own antibodies and where the cause (the infection focus) has not been remedied.
At a body temperature of > 38°C decrease of blood cultures.
Eliminate the focus of infection.
CAVE: Postoperative wounds can be clinically unremarkable, but still act as a focus of infection.
Systemic Therapy
- Clindamycin has clearly shown itself superior to ampicillin.
Clindamycin intravenously 3x daily 900 mg (adults), 3x 25-40mg/kg/d (children).
AND
Vancomycin i.v. 3x daily 15-20 mg/kg bw, but not more than 2g (adults), 4x daily 10 mg/kg/d (children).
With proven MRSA infection
Clindamycin intravenously 3x daily 900 mg (adults), 3x 25-40mg/kg/d (children).
AND
Vancomycin i.v. 3x daily 15-20 mg/kg bw, but not more than 2g (adults), 4x daily 10 mg/kg/d (children).
OR
Linezolid intravenously 2x 600 mg (adults), 2x daily 10 mg/kg bw (children).
Alternative: Vancomycin intravenously 3x daily 15-20 mg/kg bw, but not more than 2g (adults), 4x daily 10 mg/kg/d (children).
AND
In case of skin infection
Mupirocin ointment 2x daily for 5 days.
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