Pyelonephritis due to
S. aureus: an unusual case of Toxic Shock Syndrome.
By: Maureen Shevlin Gutierrez, MD
Georgetown University Internal Medicine
Washington, D.C.
Toxic Shock Syndrome (TSS)
* A rare but life-threatening bacterial illness.
* Caused by Staphylococcus aureus or by Group A Streptococcus bacteria.
* Historically, TSS has been a well recognized entity in menstruating females using tampons.
* More recently, TSS has been associated with surgical cases, skin and soft tissue infections, and postpartum complications.
* TSS requires early diagnosis and treatment as the case-fatality ratio is approximately 3% in menstrual cases, and 5% in nonmenstrual cases.
How is the diagnosis made?
* TSS is a clinical diagnosis with 6 criteria:
1. Fever
2. Hypotension
3. Rash
4. Desquamation (1-2 weeks after illness onset)
5. Abnormalities in 3 or more organ systems
6. Negative blood, throat, CSF cultures
Case Presentation
HPI
Physical Exam
Assist Control respiratory support
Laboratories
Imaging
The diagnosis
Staphylococcal Toxic Shock Syndrome
Staphylococcal TSS
Nonmenstrual cases
Literature search
Case fatality ratio
Why is it so virulent?
Virulence = Superantigens
Treatment of TSS
Patient Update
Take home points
* Toxic shock is no longer predominately a disease of menstruating females.
* Almost 50% of cases are nonmenstrual, which include post-surgical procedures, skin and soft tissue infections, and postpartum complications.
* Our literature search revealed that “unusual sites” have previously been reported.
* Our case, along with one other previously reported case, demonstrates that pyelonephritis should be added to this growing list of unusual sites of infection associated with S. aureus TSS.
* Recognition of the syndrome despite the site of infection is crucial to diagnosis and management.
Resources
Pyelonephritis.ppt
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