Toxic shock syndrome laboratory findings

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

Overview:

Laboratory findings consistent with the diagnosis of toxic shock syndrome (TSS) include leukocytosis, anemia and thrombocytopenia.

A positive blood culture is diagnostic for Streptococcal TSS, although in other causes of TSS blood culture doesn't have a high value.

Laboratory Findings

The International Guideline Committee for diagnosis of septic shock recommends obtaining appropriate cultures that may include at least two blood cultures, urine, cerebrospinal fluid, wounds, respiratory secretions, or other body fluid cultures before antimicrobial therapy is initiated. In TSS patients, blood culture for staphylococcus is not diagnostic, although blood culture for streptococcal TSS is highly diagnostic.

Primary General Electrolyte and Biomarker Studies[1][2]

Laboratory Exam Result
Complete blood count (CBC) Leukocytosis with a left shift
Hematocrit levels up to 80 percent have been reported
Thrombocytopenia with platelets <100 x 10^3/microliter
Anemia
Blood culture Bacteremia
Renal function tests Elevated serum BUN and creatinine
Urine Analysis: Hemoglobinuria
Liver Function Tests Elevated transaminases and bilirubin
hypoalbuminemia
Serum lactic acid Elevated
Metabolic tests hypocalcemia
hyponatremia
hypophosphatemia
Blood gas analysis:

Venous blood gas (VBG) and arterial blood gas analysis (ABG)

Hypoxemia may be present as a result of pulmonary edema and pleural effusion
Metabolic acidosis and elevated pH
Creatine phosphokinase (CPK) Elevated

Specialized Laboratory Tests[3]

Exam Result
Blood microscopy and culture (blood, wound, fluid, tissue) Positive for group A streptococcus or Staphylococcus aureus
Prothrombin time Prolonged in staphylococcal disease in conjunction with DIC
Partial thromboplastin time Prolonged in staphylococcal disease in conjunction with DIC
Creatine kinase (CK) Elevated in necrotizing fasciitis or myositis and in some staphylococcal disease
Polymerase chain reaction (PCR) Protracted expansion of TSST-1–reactive Vβ2-positive T cells persisting for 4–5 weeks
Serotyping Evidence of streptococcal exotoxins

References

  1. "Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections". JAMA. 269 (3): 390–1. 1993. PMID 8418347.
  2. Adams EM, Gudmundsson S, Yocum DE, Haselby RC, Craig WA, Sundstrom WR (1985). "Streptococcal myositis". Arch. Intern. Med. 145 (6): 1020–3. PMID 3890787.
  3. Davis JP, Osterholm MT, Helms CM, Vergeront JM, Wintermeyer LA, Forfang JC, Judy LA, Rondeau J, Schell WL (1982). "Tri-state toxic-shock syndrome study. II. Clinical and laboratory findings". J. Infect. Dis. 145 (4): 441–8. PMID 7069224.


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