Staphylococcal Toxic Shock Syndrome
- An acute toxin-mediated illness associated with Staphylococcus aureus infection
- Toxic shock syndrome (TSS) is characterized by sudden onset of high fever and rash with subsequent hypotension, desquamation, and involvement of ≥3 organ systems (1):
- Menstrual (less common): associated with menstruation and tampon use
- Nonmenstrual (more common): associated with postoperative wounds and barrier contraception
- Can occur in children and adults
- System(s) affected: multiple
- Predominant age: 15 to 35 years; can occur at any age
- Predominant sex: female > male
- Nonmenstrual cases increasingly associated with methicillin-resistant S. aureus (MRSA) infections and carry a higher mortality rate (1)
- Newborn: neonatal TSS-like exanthematous disease syndrome
59 to 78 cases per year reported to the CDC from 2011 to 2015 (2)
Etiology and Pathophysiology
- S. aureus exotoxins, especially TSS toxin-1 (TSST-1) (in >90% of menstrual cases)
- Staphylococcal enterotoxins A to E and G to I
- Enterotoxins B and C cause 50% of nonmenstrual TSS.
- Production and release of staphylococcal superantigens that bind to APC MHC class II and V-β region of T-cell receptor
- T cells are activated, releasing cytokines (interleukin [IL]-1, IL-2, γ-interferon, tumor necrosis factor [TNF]-α, TNF-β, IL-6) that cause capillary leak, hypotension, and shock.
- Use of regular absorbency tampons during menstruation
- Surgical wound infections
- Early postpartum state, especially after cesarean section or episiotomy
- Pediatric considerations
- TSS may occur as a complication of chickenpox or burns. TSS is the most common cause of unexpected mortality after small burns in children. Prophylactic antibiotic use is not indicated in this situation (3).
- Appropriate use of feminine hygiene products
- Early attention to infected wounds
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