Background
Case presentation
Parameter | Recorded value | Reference value |
---|---|---|
White blood cell count | 0.80 × 103/µL | 4.50–7.50 × 103/µL |
Neutrophils | 73% | 42–74% |
Lymphocytes | 19% | 18–50% |
Hemoglobin | 14.5 g/dL | 11.3–15.2 g/dL |
Hematocrit | 46.1% | 36–45% |
Platelets | 78 × 103/µL | 130–350 × 103/µL |
C-reactive protein | 368 mg/L | ≤ 10 |
Procalcitonin (PCT) | 115,45 ng/ml | < 0.1 negative |
Total protein | 45 g/L | 63–82 g/L |
Albumin | 26 g/L | 35–50 g/L |
Aspartate aminotransferase | 20 U/L | 38–126 U/L |
Alanine aminotransferase | 45 U/L | 21–72 U/L |
Lactate dehydrogenase | 644 U/L | 120–246 U/L |
Creatine phosphokinase (CPK) | 3405 U/L | 55–170 U/L |
Blood nitrogen urea | 60 mg/dL | 19–43 mg/dL |
Creatinine | 2.7 mg/dL | 0.66–1.25 mg/dL |
Sodium | 140 mEq/L | 137–145 mEq/L |
Potassium | 3.61 mEq/L | 3.5–5.0 mEq/L |
Glucose | 136 mg/dL | 74–106 mg/dL |
D-Dimer | 39,419 mg/dl | < 500 negative |
Fibrinogen | 838 mg/dl | 180–350 |
APTT | 55 s | 23.9–34,9 |
Rapid influenza test | Positive for type B |
Discussion and conclusion
Clinical Criteria |
---|
Fever: temperature greater than or equal to 38.9 °C |
Rash with diffuse macular erythroderma |
Desquamation: 1–2 weeks after onset of rash |
Hypotension: systolic blood pressure less than or equal to 90 mm Hg for adults or less than fifth percentile by age for children aged less than 16 years |
Multisystem involvement (three or more of the following organ systems): o Gastrointestinal: vomiting or diarrhea at onset of illness o Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal o Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia o Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection o Hepatic: total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory o Hematologic: platelets less than 100,000/mm3 o Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent |
Laboratory Criteria |
Negative results on the following tests, if obtained: Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus) Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles |
Case Classification |
Probable A case which meets the laboratory criteria and in which four of the five clinical criteria described above are present |
Confirmed A case which meets the laboratory criteria and in which all five of the clinical criteria described above are present, including desquamation, unless the patient dies before desquamation occurs |
Author (year) | Age of patient/sex | CoN Strain isolated | TSS criteria | Treatment | Outcome | Comments |
---|---|---|---|---|---|---|
Goda K, et al. (2021) [10] | 75 yrs/female | Staphylococcus simulans | 4/5 | Initial treatment meropenem (1 g every 8 h), vancomycin (1 g every 12 h, therapeutic drug monitoring: ≥15 µg/mL), and clindamycin (600 mg every 8 h). Targeted treatment: cefazolin (1 g q8h) and clindamycin (600 mg q8h), duration 14 days. | Not reported | Pneumococcal pneumonia and bacteremia from S. simulans following an influenza type A infection Increased levels of cytokines |
Pomputius WF, et al. (2023 [11] | 8yrs/ male | Staphylococcus epidermidis | 5/5 | vancomycin (hospital day 1–5), ceftriaxone (hospital day 1–8), clindamycin (hospital day 1–5), and acyclovir (hospital day 2–4). Doxycycline was begun on hospital day 4 and continued for a 10-day course, given concern forpossible Chlamydia or Mycoplasma encephalitis. No intravenous immunoglobulin or steroids were given. | survived | Positive urine culture of S. epidermidis. Four superantigen genes were detected in the plasma |
Armeftis C, et al. (2023) | 46yrs/ male | Staphylococcus epidermidis | 5/5 | meropenem (1 g every 8 h), vancomycin (1 g every 12 h), levofloxacin (750 mg 24 h), clindamycin (600 mg every 8 h), IVIG (2 g/kg) and hydrocortisone (100 mg every 8 h). The patient became afebrile within the first 72 h of ICU admission. | survived | TSS caused by Staphylococcus epidermitis following an influenza type B infection. |