Toxic shock syndrome

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),[1]Centers for Disease Control and Prevention Working Group on Severe Streptococcal Infections. Defining the group A streptococcal toxic shock syndrome: rationale and consensus definition. JAMA. 1993 Jan 20;269(3):390-1. http://www.ncbi.nlm.nih.gov/pubmed/8418347?tool=bestpractice.com [2]Centers for Disease Control and Prevention. Streptococcal toxic shock syndrome (STSS): 2010 case definition. 2010 [internet publication]. http://wwwn.cdc.gov/NNDSS/script/casedef.aspx?CondYrID=858&DatePub=1/1/2010%2012:00:00%20AM or methicillin-sensitive (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus.[3]Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep. 1997 May 2;46(10):1-55. http://www.cdc.gov/mmwr/preview/mmwrhtml/00047449.htm http://www.ncbi.nlm.nih.gov/pubmed/9148133?tool=bestpractice.com 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.[4]Reingold AL, Hargrett NT, Shands KN, et al. Toxic shock syndrome surveillance in the United States, 1980 to 1981. Ann Intern Med. 1982 Jun;96(6 Pt 2):875-80. http://www.ncbi.nlm.nih.gov/pubmed/7091960?tool=bestpractice.com [5]Kotler DP, Sandkovsky U, Schlievert PM, et al. Toxic shock-like syndrome associated with staphylococcal enterocolitis in an HIV-infected man. Clin Infect Dis. 2007 Jun 15;44(12):e121-3. http://cid.oxfordjournals.org/content/44/12/e121.long http://www.ncbi.nlm.nih.gov/pubmed/17516392?tool=bestpractice.com [6]Paterson MP, Hoffman EB, Roux P. Severe disseminated staphylococcal disease associated with osteitis and septic arthritis. J Bone Joint Surg Br. 1990 Jan;72(1):94-7. http://www.bjj.boneandjoint.org.uk/content/72-B/1/94.long http://www.ncbi.nlm.nih.gov/pubmed/2298804?tool=bestpractice.com [7]Ferguson MA, Todd JK. Toxic shock syndrome associated with Staphylococcus aureus sinusitis in children. J Infect Dis. 1990 May;161(5):953-5. http://www.ncbi.nlm.nih.gov/pubmed/2324544?tool=bestpractice.com [8]Parsonnet J. Nonmenstrual toxic shock syndrome: new insights into diagnosis, pathogenesis, and treatment. Curr Clin Top Infect Dis. 1996;16:1-20. http://www.ncbi.nlm.nih.gov/pubmed/8714246?tool=bestpractice.com