An exotoxin-mediated illness caused by bacterial infection, most commonly group A streptococcus or Staphylococcus aureus.
Presenting signs and symptoms can be non-specific, but the course of the disease is precipitous and toxicity occurs early, resulting in serious life-threatening disease and multi-organ system failure.
Early diagnosis and treatment is essential.
Streptococcal toxic shock syndrome (TSS) can occur with infection at any site but is more commonly associated with an infected cutaneous site.
Staphylococcal TSS (menstrual or non-menstrual) is associated with extended tampon use, postpartum infections, and other sites of infection with the organism.
Treatment includes supportive care in an ICU, early empirical antibiotic treatment, and further culture-sensitive antibiotic treatment. Surgical debridement may be needed for deep-seated streptococcal infections.
Toxic shock syndrome (TSS) is an exotoxin-mediated illness caused by bacterial infection. Organisms commonly responsible include group A streptococcus (Streptococcus pyogenes), or methicillin-sensitive (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus. Although the presenting signs and symptoms can be non-specific (e.g., fever, chills, myalgias, headache), the course of the disease is precipitous, and shock and multi-organ system failure occur early in the course of the disease.
Staphylococcal TSS can be split into 2 groups: menstrual TSS, which occurs in women during menstruation with extended use of a single tampon or, historically, with highly absorbable tampons; and non-menstrual TSS, which can result from a variety of staphylococcal post-partum vaginal and caesarean wound infections.
History and exam
- diabetes mellitus
- minor trauma and injuries with bruising, haematoma formation, or muscle strain
- surgical procedures (e.g., vaginal delivery, breast reconstruction, caesarean section, hysterectomy, liposuction, bunionectomy)
- single tampon used continuously for consecutive days during menses
- using highly absorbent tampons
- NSAID use
- using contraceptive sponges, diaphragms, and IUDs
- untreated strep throat
Walid Khayr, MD
Professor of Medicine
Rosalind Franklin University of Medicine and Science
Infectious Disease Section Chief
Veteran Affairs Medical Center
WK declares that he has no competing interests.
Dr Khayr would like to gratefully acknowledge Dr Marie R. Baldisseri, a previous contributor to this topic. MRB declares that she has no competing interests.
Mary Jane Reed, MD, FACS, FASMBS
Department of Critical Care Medicine and Department of General Surgery
Geisinger Medical Center
MJR declares that she has no competing interests.
Janice Zimmerman, MD
Critical Care Division
The Methodist Hospital
JZ declares that she has no competing interests.
Djillali Annane, MD, PhD
Professor in Medicine at University of Versailles SQY
Director of the General ICU at Raymond Poincaré Hospital (AP-HP)
Director of the Center for Clinical Research and Technology Innovation (INSERM)
DA is an author of a number of references cited in this topic.
World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E) consensus conference: recommendations for the management of skin and soft-tissue infections external link opens in a new windowMore guidelines
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