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Potentially life-threatening emergency
Toxic shock syndrome in Infant/Neonate
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Potentially life-threatening emergency

Toxic shock syndrome in Infant/Neonate

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Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

Toxic shock syndrome (TSS) is an acute toxin-mediated illness characterized by fever, hypotension, multisystem involvement, and a rash. It is caused by superantigens (eg, toxic shock syndrome toxin 1 [TSST-1] or staphylococcal enterotoxins) released by toxin-producing strains of Staphylococcus aureus. Superantigens activate T-lymphocytes by linking T-cell receptors to class II major histocompatibility complex antigens on the surface of antigen-presenting cells, resulting in massive cytokine release. The extent of subsequent multiorgan system dysfunction is directly related to the severity of hypotension.

TSS may result from surgical wounds, burns, or any other type of mucous membrane, skin, or soft tissue infection with S. aureus. If the US Centers for Disease Control (CDC) criteria are strictly followed, TSS is extremely rare in infants (refer to Look For section for CDC Definition of Staphylococcal TSS). Partial expression may be due to passive immunity conferred by maternal antibodies during the first 3-6 months of life; the increased tolerance of infantile T-cells to superantigens; and early treatment leading to a blunted course. Names for these partial expressions of toxin-mediated disease include neonatal toxic shock syndrome-like exanthematous disease (NTED) and staphylococcal toxemia.

Codes

ICD10CM:
A48.3 – Toxic shock syndrome

SNOMEDCT:
18504008 – Toxic shock syndrome

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Consider streptococcal toxic-shock-like syndrome, which has a similar clinical presentation. Patients are usually aged 20-50 years and have a deep soft-tissue infection.

Other diagnoses within the differential diagnosis are:

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 01/11/2018
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Potentially life-threatening emergency
Toxic shock syndrome in Infant/Neonate
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View all Images (5)
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Toxic shock syndrome : Diarrhea, Fever, Headache, ALT elevated, AST elevated, Creatinine elevated, Delirium, Edema, Erythroderma, Widespread, Myalgia, HR increased, BP decreased
Clinical image of Toxic shock syndrome
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