see also: [[paediatric sepsis]], [[CRP]] see: [RCH - Invasive Group A strep household contacts](https://www.rch.org.au/clinicalguide/guideline_index/Invasive_group_A_streptococcal_infections__management_of_household_contacts/), [Victoria invasive group A strep](https://www.health.vic.gov.au/infectious-diseases/invasive-group-a-streptococcal-disease-igas) #incomplete # Gram negative # Gram positive ## Toxic Shock syndrome - high fever - hypotension and shock - diffuse macular erythroderma rash - desquamation, especially palms and soles - generally rapid onset - multi-system organ involvement - staph may grow in blood, but blood cultures often negative - *staph aureus* only rarely recovered from blood cultures in toxic shock - *group A strep* often cultured in blood ### Staphylcoccal toxic shock - menstrual (tampons introduces oxygen, required for TSS-1 production_ - surgical wound infeciton - mastitits - osteomylitis - burns - immunodefficiency ### Streptococcal toxic shock > AKA "[invasive group A strep](https://www.health.vic.gov.au/infectious-diseases/invasive-group-a-streptococcal-disease-igas)" or GAS. strep growing in a place it's not supposed to be - [[Necrotising infections|necrotising fasciitis]] - severe [[Maternal Sepsis|puerperal sepsis]] - necrotising pneumonia - suppurative pharyngitis - [[bone and joint infection (paeds)|septic arthritis]] - [[Meningitis]] *Treatment* - add clindamycin 600mg tds (prevent synthesis of toxic shock protein) - consider IVIG 2g/kg up to 2 doses in severe cases )to remove circulating toxin) - fairly poor evidence; all evidence in support came from the same group of researchers # clinical parameters ## CRP see [[CRP]] ## Rigours - shaking chills increases the likelihood of bacteraemia (positive likelihood ratio of 4.7) - [Tokuda et al 2005](https://pubmed.ncbi.nlm.nih.gov/16378800/) ## SIRS ## neutrophil-lymphocyte ratio