CURRENT Essentials of Critical Care.pdf

Chapter 10 Infectious Disease 157■■■Toxic Shock SyndromeEssentials of Diagnosis• Multisystem illness characterized by rapid onset of fever, vomiting,watery diarrhea, pharyngitis, profound myalgias with accompanyinghypotension• Diffuse blanching truncal erythema early, accentuated in axillaryand inguinal folds, spreading to extremities• Desquamation of skin, palms and soles occurs in second or thirdweek• Multiorgan system involvement, with acute renal failure, ARDS,refractory shock, ventricular arrhythmias, and DIC may occur• Highest incidence in menstruating women, persons with localizedor postsurgical staphylococcal infection, and women usingdiaphragm or contraceptive spongeDifferential Diagnosis• Scarlet fever/Streptococcal toxic-shock-like disease• Kawasaki’s disease• Rocky Mountain spotted fever• Drug eruptions/Stevens-Johnson syndrome• Measles• Leptospirosis• Sepsis syndrome with multiorgan system failureTreatment• Immediate removal of tampon, contraceptive device, or surgicalpacking• Surgical drainage, irrigation of focal abscess• Supportive care, with fluid resuscitation and management of organsystem failure• Antistaphylococcal antibiotic, though effect on outcome unclear■ PearlIntense hyperemia of conjunctival, oropharyngeal, and vaginal surfacesare frequent findings in toxic shock syndrome.ReferenceProvost TT, Flynn JA (editors): Cutaneous Medicine: Cutaneous Manifestationsof Systemic Disease. BC Decker, 2001.