Toxic shock syndrome physical examination

Toxic shock syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Toxic Shock Syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Toxic shock syndrome physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Toxic shock syndrome physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Toxic shock syndrome physical examination
CDC on Toxic shock syndrome physical examination
Toxic shock syndrome physical examination in the news
Blogs on Toxic shock syndrome physical examination
Directions to Hospitals Treating Toxic shock syndrome
Risk calculators and risk factors for Toxic shock syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Patients with toxic shock syndrome (TSS) usually present with shock. Physical examination of patients with TSS is usually remarkable for hypotension, fever, and diffuse erythroderma. The presence of desquamation on physical examination is highly suggestive of TSS.

Physical Examination

Physical exam in TSS patients usually include these findings:

Appearance of the Patient

• TSS is presented by its shock symptoms.
• May be ill appearing in the early stages of the disease, progress to confusion and change in mental status by disease progress.

Vital Signs

• High grade Fever
• Hypotension
  • Systolic blood pressure of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of isotonic intravenous fluids
• Tachycardia
  • As a result of shock and hypotension
• Tachypnea
  • May be pressent as a result of pulmonary edema secondary to shock

Skin

• Diffuse pruritic maculopapular rash with palm and soles desquamation
• Erythroderma
• Superficial ulcerations
• Petechiae
• Vesicles
• Bullae (specially in Streptococcal TSS)
• Skin desquamation (apears weeks after disease onset)
• Non-pitting edema
• Hair and nail loss

• Cyanosis

HEENT

• Ophthalmoscopic exam may be abnormal with findings of conjunctival-scleral hemorrhage
• Hyperemia of oropharyngeal mucosa

Lungs

• Wet rales due to pulmonary edema complication

Heart

• Possibly a diastolic gallop (S3) due to pulmonary edema

Extremities

• Non-pitting edema
  • Can develop as a result of increases in interstitial fluid

Neuromuscular

• Patient is usually oriented but if the disease is not diagnosed, it can lead to altered mental status and confusion
• Hyporeflexia can be seen as a result of associated hypocalcemia/ hypophosphatemia
• Muscle cramps (as a result of hypocalcemia, a contributing complication of renal failure)
• Seizure

References

Template:WikiDoc Sources