- Discussion:
- toxic shock is an acute febrile syndrome that was originally described in association with the use of highly absorbent tampons but is now recognized to occur
as a postoperative complication of many different surgical procedures;
- toxins produced by
staphylococcus aureus (or
streptococcus) are probably responsible for this syndrome;
- migmatoxin produced by staph aureus, may be the most importnat toxin in toxic shock syndrome;
-
clinical features:
- streptococcal toxic shock syndrome:
- isolation of group A streptococci
- hypotension
- coagulopathy
- soft-tissue necrosis
- myositis or gangrene
- hepatic involvement
- renal impairment
- generalized erythematous macular rash
- acute respiratory distress syndrome
- staphylococcal toxic shock syndrome:
- includes the above in addition to fever and a rash with desquamation;
- soft-tissue necrosis is not common
- Clinical Presentation:
- dx is based on clinical findings & requires following criteria:
- fever greater than 38.9 C (102 F), hypotension (systolic pressure of 90 mm Hg or less), a diffuse macular rash, and evidence of multiple (three
or more) organ system dysfunction;
- local signs of wound infection are typically absent or minimal which unfortunately may lead to delayed diagnosis;
- rash is usually followed by desquamation after 1 to 2 weeks;
- Treatment:
- aggressive fluid administration;
-
parenteral antibiotics;
-
clindamycin 600 mg IV q 8 hrs;
- effective against streptococcus and most staph aureus.
-
penicillin G (4 million units IV q 4 hours);
- wound debridement w/ removal of any foriegn bodies or metal implants;
- some advocate systemic corticosteroids as well;
Posttraumatic toxic shock syndrome. Knudson P, Charney M, Salcido D: Trauma 1988;28(1):121-123.
Fatal toxic shock syndrome as complication of orthopaedic surgery. Rovner RA, Baird RA, Malerich MM, et al: J Bone Joint Surg 1984;66A:952-954.
Toxic shock syndrome in association with group A streptococcal infection of a total knee joint after a total knee arthroplasty.
Toxic shock syndrome in patients with external fixators. R. Tucker et al. J. Pediatric Orthopaedics. Vol 12. 1992. p 658-662.
Toxic shock syndrome in association with group A streptoccoal infection of a knee joint after a total knee arthroplasty. ED Ralph MD et al. JBJS. Vol 80-A. No 1. Jan. 1998. p 96.
Non-menstrual toxis shock syndrome complicating orthopaedic surgery. Letter to the editor. J. Croall and S. Chandhri. J. Infect. Vol 18 1989. p 195-196.
Streptococcal Toxic Shock Syndrome Presenting as Septic Knee Arthritis in a 5-Year-Old Child.
Case 2-2009 — A 25-Year-Old Man with Pain and Swelling of the Right Hand and Hypotension
