Toxic shock syndrome in Infant/Neonate
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.
A48.3 – Toxic shock syndrome
18504008 – Toxic shock syndrome
Other diagnoses within the differential diagnosis are:
- Kawasaki disease – Fever lasting for more than 5 days with oral mucosal changes, conjunctival injection, and cervical lymphadenopathy.
- Meningococcemia – Rapid decompensation, characteristic petechial eruption caused by N meningitidis.
- Staphylococcal scalded skin syndrome
- Drug hypersensitivity syndrome (DRESS)
- Viral exanthem
- Exanthematous drug eruption
- Drug-induced erythroderma
- Toxic epidermal necrolysis (TEN) – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Stevens-Johnson syndrome – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Scarlet fever – 1-mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.
- Erythrodermic psoriasis
- Atopic dermatitis with erythroderma
- Contact dermatitis
- Pemphigus erythematosus
- Pityriasis rubra pilaris
- Sezary syndrome (see cutaneous T-cell lymphoma)
- Necrotizing fasciitis – Rapidly progressing necrosis of fascia and subcutaneous fat.
- Rocky Mountain spotted fever – Characteristic retiform purpura; check for serologies.
- Rubeola (measles)