Toxic shock syndrome differential diagnosis: Difference between revisions
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|Lymphadenopathy | |Lymphadenopathy and conjunctvitis | ||
|Not present | |Not present | ||
|Present(acute, non-purulent, cervical) | |Present(acute, non-purulent, cervical) | ||
|Cervical lymphadenopathy may be present | |Cervical lymphadenopathy may be present. Scarlet fever appears similar to Kawasaki's disease in some aspects, but lacks the eye signs or the swollen, red fingers and toes | ||
|- | |- | ||
|Metabolic and electrolyte imbalances | |Metabolic and electrolyte imbalances | ||
|Present (hyponatremia and uremia) | |Present (hyponatremia and uremia). Hepatic (total bilirubin, serum asparate aminotransferase or serum alanine aminotransferase levels >2 times upper normal limit) | ||
|Liver function tests may show evidence of hepatic inflammation and low serum albumin levels | |Liver function tests may show evidence of hepatic inflammation and low serum albumin levels | ||
|Not present | |Not present | ||
|- | |- | ||
|Hematologic and cardiovascular testing | |Hematologic and cardiovascular testing | ||
| | |Leukocytosis with a polymorphonuclear shift to the left. Platelets < 100,000 per mm<sup>3</sup> | ||
|Low hemoglobulin and age-adjusted hemoglobulin concentrations, thrombocytosis, anemia. Echocardiographic abnormalities, such as valvulitis (mitral or tricuspid regurgitation) and coronary artery lesions, are significantly more common in the Kawasaki disease. <ref name="pmid26222065">{{cite journal |vauthors=Lin YJ, Cheng MC, Lo MH, Chien SJ |title=Early Differentiation of Kawasaki Disease Shock Syndrome and Toxic Shock Syndrome in a Pediatric Intensive Care Unit |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=11 |pages=1163–7 |year=2015 |pmid=26222065 |doi=10.1097/INF.0000000000000852 |url=}}</ref> | |Low hemoglobulin and age-adjusted hemoglobulin concentrations, '''thrombocytosis''', anemia. Echocardiographic abnormalities, such as valvulitis (mitral or tricuspid regurgitation) and coronary artery lesions, are significantly more common in the Kawasaki disease. <ref name="pmid26222065">{{cite journal |vauthors=Lin YJ, Cheng MC, Lo MH, Chien SJ |title=Early Differentiation of Kawasaki Disease Shock Syndrome and Toxic Shock Syndrome in a Pediatric Intensive Care Unit |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=11 |pages=1163–7 |year=2015 |pmid=26222065 |doi=10.1097/INF.0000000000000852 |url=}}</ref> | ||
|Leukocytosis with left shift and possibly eosinophilia a few weeks after convalescence. Anti-deoxyribonuclease B, antistreptolysin-O titers (antibodies to streptococcal extracellular products), antihyaluronidase, and antifibrinolysin may be positive. | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Differentiating Toxic Shock Syndrome from other Diseases
Toxic shock syndrome requires all 3 manifestations of fever, hypotension and diffuse scarlatiniform rash (innumerable small red papules that are diffusely distributed plus erythema, which blanches and desquamates one or two weeks after onset of illness). It presents with various signs of infection, hemodynamic dysfunction and organ failure.
Clinical presentation of sepsis and rash needs to be differentiated from other diseases like:
- Staphylococcal scalded skin syndrome
- Exfoliative erythroderma syndrome
- Erythema multiforme major
- Drug eruption
| Features | Toxic shock syndrome | Kawasaki disease | Scarlet fever |
|---|---|---|---|
| Epidemiology | Occurs in both adults and children (9:1 female predominance) | Occurs in children, usually age 1-4 years | Distributed equally among both genders. Most commonly affects children between five and fifteen years of age. |
| Predisposing factors | Occurs in association with vaginitis during menstruation following tampon use (S. aureus); as a complication of soft tissue infections (S. pyogenes or GAS) or in females undergoing medical abortion (C. sordelii). | Interaction of genetic and environmental factors, possibly including an infection in combination with genetic predisposition to an autoimmune mechanism (autoimmune vasculitis) | Occurs after streptococcal pharyngitis/tonsillitis |
| Hypotension | Commonly present | Not present | Uncommon |
| Diarrhea | Present | May be present | Not present |
| Pastia's sign (puncta and skin crease accentuation of the erythema) | Not present | Not present | Present |
| Renal faliure | Present | Not present | Uncommon |
| Pyuria | Renal origin | Uretheral origin | |
| Lymphadenopathy and conjunctvitis | Not present | Present(acute, non-purulent, cervical) | Cervical lymphadenopathy may be present. Scarlet fever appears similar to Kawasaki's disease in some aspects, but lacks the eye signs or the swollen, red fingers and toes |
| Metabolic and electrolyte imbalances | Present (hyponatremia and uremia). Hepatic (total bilirubin, serum asparate aminotransferase or serum alanine aminotransferase levels >2 times upper normal limit) | Liver function tests may show evidence of hepatic inflammation and low serum albumin levels | Not present |
| Hematologic and cardiovascular testing | Leukocytosis with a polymorphonuclear shift to the left. Platelets < 100,000 per mm3 | Low hemoglobulin and age-adjusted hemoglobulin concentrations, thrombocytosis, anemia. Echocardiographic abnormalities, such as valvulitis (mitral or tricuspid regurgitation) and coronary artery lesions, are significantly more common in the Kawasaki disease. [1] | Leukocytosis with left shift and possibly eosinophilia a few weeks after convalescence. Anti-deoxyribonuclease B, antistreptolysin-O titers (antibodies to streptococcal extracellular products), antihyaluronidase, and antifibrinolysin may be positive. |
References
- ↑ Lin YJ, Cheng MC, Lo MH, Chien SJ (2015). "Early Differentiation of Kawasaki Disease Shock Syndrome and Toxic Shock Syndrome in a Pediatric Intensive Care Unit". Pediatr. Infect. Dis. J. 34 (11): 1163–7. doi:10.1097/INF.0000000000000852. PMID 26222065.