The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department

A Review of the Literature

Michael Gottlieb, Brit Long, Alex Koyfman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. Objective: This review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS. Discussion: The most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid. Conclusion: TSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.

Original languageEnglish (US)
Pages (from-to)807-814
Number of pages8
JournalJournal of Emergency Medicine
Volume54
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Septic Shock
Hospital Emergency Service
Linezolid
Evidence-Based Emergency Medicine
Focal Infection
Anti-Bacterial Agents
Penicillinase
Soft Tissue Injuries
Chills
Aftercare
Clindamycin
Pharyngitis
Streptococcus pyogenes
Cephalosporins
Vancomycin
Therapeutics
Erythema
Methicillin-Resistant Staphylococcus aureus
Disease Management
Exanthema

Keywords

  • desquamation
  • erythroderma
  • fever
  • hypotension
  • infection
  • rash
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • toxic shock syndrome
  • toxin

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department : A Review of the Literature. / Gottlieb, Michael; Long, Brit; Koyfman, Alex.

In: Journal of Emergency Medicine, Vol. 54, No. 6, 01.06.2018, p. 807-814.

Research output: Contribution to journalArticle

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