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Síndrome do choque tóxico

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 14 Aug 2025
Last updated: 22 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • dor intensa difusa ou localizada em um membro
  • febre
  • edema ou eritema localizados
  • hipotensão
  • rash eritematoso difuso escarlatiniforme
Full details

Other diagnostic factors

  • alterações agudas do estado mental
  • sintomas tipo influenza
  • sensibilidade e fraqueza muscular
  • sintomas gastrointestinais
  • sinais e sintomas de miocardite
  • endoftalmite
  • hipotermia
Full details

Risk factors

  • diabetes mellitus
  • transtornos decorrentes do uso de bebidas alcoólicas
  • traumas menores e lesões com hematomas, formação de hematomas ou distensão muscular
  • procedimentos cirúrgicos (por exemplo, parto vaginal, reconstrução da mama, parto cesáreo, histerectomia, lipossucção, bunionectomia)
  • uso prolongado (>6 horas) do mesmo absorvente higiênico interno
  • uso de absorventes higiênicos internos de alta absorção
  • uso de anti-inflamatórios não esteroidais (AINEs)
  • uso de esponjas vaginais, diafragmas e dispositivos intrauterinos (DIUs)
  • faringite estreptocócica não tratada
Full details

Diagnostic investigations

1st investigations to order

  • microscopia e cultura (sangue, ferida, líquido, tecido)
  • Hemograma completo
  • perfil de coagulação
  • ureia e creatinina séricas
  • urinálise
  • TFHs
  • creatina quinase (CK)
  • cálcio sérico
  • sódio sérico
  • fósforo sérico
  • albumina sérica
  • ácido lático sérico
Full details

Investigations to consider

  • teste de anticorpos anti-Staphylococcus aureus
  • radiografia torácica
Full details

Emerging tests

  • sorotipagem

Treatment algorithm

INITIAL

suspeita de síndrome do choque tóxico

ACUTE

síndrome do choque tóxico estreptocócico confirmada

síndrome do choque tóxico estafilocócico confirmada: sensível à meticilina

síndrome do choque tóxico estafilocócico confirmada: resistente à meticilina

síndrome do choque tóxico clínico sem culturas confirmadas

Contributors

Authors

Brit Jeffrey Long, MD

Attending Physician

Associate Professor of Emergency Medicine

Department of Emergency Medicine

Brooke Army Medical Center

Fort Sam Houston

TX

Disclosures

BJL declares that he has no competing interests.

Acknowledgements

Dr Brit J. Long would like to gratefully acknowledge Dr Marie R. Baldisseri and Dr Walid Khayr, previous contributors to this topic.

Disclosures

MRB and WK declare they have 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Streptococcal toxic shock syndrome (STSS): 2010 case definition. 2010 [internet publication].​Full text

Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.Full text  Abstract

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.Full text  Abstract

Sartelli M, Guirao X, Hardcastle TC, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018;13:58.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

    • Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2021
    • Invasive group A streptococcal disease: management and chemoprophylaxis
    More Guidelines
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