Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Staphylococcal Infections 1373

➣May present in bones, joints, lungs and kidneys as suppurative

collections via hematogenous spread

➣Suspect metastatic infections if persistent fevers despite treat-

ment for bacteremia or endocarditis

■Food poisoning:

➣Toxin-mediated disease due to S. aureus

➣Presents with nausea, vomiting followed by abdominal cramps

and watery diarrhea 2–4 hours following ingestion of contami-

nated food

➣Usually appears in outbreaks

➣Patients not febrile and without rash

■Toxic shock syndrome:

➣Toxin-mediated disease due to S. aureus

➣In 1980–81 became increasingly seen with the introduction of

super absorbent tampons

➣Appears abruptly with fever, vomiting, diarrhea and myalgias;

hypotension follows and a “sunburn” rash later appears with

desquamation of the palms and soles; multiorgan involvement

is common

➣Non-menstrual cases may be associated with surgery or localized

infections and present in a similar way

tests

Laboratory

■Blood culture or specimen gram stain and culture from suspected

site of infection (sputum, urine, joint fluid, etc) confirms diagnosis

in most cases

Imaging

■CXR: can give clues as to etiology; think of right-sided endocarditis if

nodular appearance of septic emboli; can become cavitary in a few

days

■Bone films, CT or MRI: can be helpful in diagnosis of septic arthritis/

osteomyelitis

■Bone scan and indium WBC scan: can be used to diagnose osteo-

myelitis

➣Transesophageal echocardiogram: preferred over transthoracic

echocardiogram for diagnosis of endocarditis

differential diagnosis

■Includes other pyogenic bacteria that cause similar syndromes