Summary
Definition
History and exam
Key diagnostic factors
- severe diffuse or localized pain in an extremity
- fever
- localized swelling or erythema
- hypotension
- diffuse, scarlatina-like erythematous rash
Other diagnostic factors
- acute mental status changes
- influenza-like symptoms
- muscular tenderness and weakness
- abdominal pain and tenderness
- features of myocarditis
- endophthalmitis
- hypothermia
Risk factors
- diabetes mellitus
- alcoholism
- minor trauma and injuries with bruising, hematoma formation, or muscle strain
- surgical procedures (e.g., vaginal delivery, breast reconstruction, cesarean section, hysterectomy, liposuction, bunionectomy)
- single tampon used continuously for consecutive days during menses
- use of highly absorbent tampons
- NSAID use
- use of contraceptive sponges, diaphragms, and IUDs
- untreated strep throat
Diagnostic investigations
1st investigations to order
- microscopy and culture (blood, wound, fluid, tissue)
- CBC
- prothrombin time
- partial thromboplastin time
- serum BUN and creatinine
- urinalysis
- LFTs
- creatine kinase (CK)
- serum calcium
- serum albumin
- serum lactic acid
Investigations to consider
- Staphylococcus aureus antibody testing
- chest x-ray
Emerging tests
- serotyping
Treatment algorithm
suspected toxic shock syndrome
confirmed streptococcal toxic shock syndrome
confirmed staphylococcal toxic shock syndrome: methicillin-sensitive
confirmed staphylococcal toxic shock syndrome: methicillin-resistant
clinical toxic shock syndrome without confirmed cultures
Contributors
Authors
Walid Khayr, MD
Professor of Medicine
Rosalind Franklin University of Medicine and Science
Infectious Disease Section Chief
Veteran Affairs Medical Center
North Chicago
IL
Disclosures
WK declares that he has no competing interests.
Acknowledgements
Dr Khayr would like to gratefully acknowledge Dr Marie R. Baldisseri, a previous contributor to this topic. MRB declares that she has no competing interests.
Peer reviewers
Mary Jane Reed, MD, FACS, FASMBS
Associate Professor
Department of Critical Care Medicine and Department of General Surgery
Geisinger Medical Center
Danville
PA
Disclosures
MJR declares that she has no competing interests.
Janice Zimmerman, MD
Head
Critical Care Division
The Methodist Hospital
Houston
TX
Disclosures
JZ declares that she has no competing interests.
Djillali Annane, MD, PhD
Professor in Medicine at University of Versailles SQY
Director of the General ICU at Raymond Poincaré Hospital (AP-HP)
Director of the Center for Clinical Research and Technology Innovation (INSERM)
Garches
France
Disclosures
DA is an author of a number of references cited in this topic.
Differentials
- Gram-negative sepsis
- Rocky Mountain spotted fever (RMSF)
- Acute meningococcemia
More DifferentialsGuidelines
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2021
- World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E) consensus conference: recommendations for the management of skin and soft-tissue infections
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer