Onset of symptoms: 2 to 7 days after inciting event (if identified)
Clinical findings:
(1) hypotension progressing to shock
(2) afebrile
(3) nausea and vomiting
(4) dizziness
(5) generalized weakness with lethargy
(6) diarrhea
(7) chills
(8) marked tachycardia
(9) peripheral edema, pulmonary edema, pleural effusions and ascites
(10) mild pain at sites of infection
The lack of fever may be misleading and delay diagnosis.
Laboratory findings:
(1) very high white blood cell count (leukemoid reaction)
(2) low serum albumin and total protein
(3) hemoconcentration with high hematocrit
(4) thrombocytopenia
(5) metabolic acidosis
(6) elevated creatinine with renal failure
(7) hypoxemia with respiratory failure
Poor prognostic findings:
(1) septic shock with multi-organ failure
(2) leukemoid reaction with WBC > 75,000 per µL
(3) capillary leak syndrome very low serum albumin (<= 1.0 g/dL)
Mortality rate: 50 - 70%, typically 2-6 days after onset of symptoms
