Toxic-shock syndrome

Toxic-shock syndrome

Toxic-shock syndrome (TSS) is a rare, life-threatening complication of certain types of bacterial infections. Often associated with the use of superabsorbent tampons, TSS can also occur in men, children, and non-menstruating women. It is caused by toxins produced by the bacteria Staphylococcus aureus and, less commonly, Streptococcus pyogenes.

Etiology

TSS is primarily caused by the exotoxins produced by the bacteria Staphylococcus aureus and Streptococcus pyogenes. These toxins act as superantigens, triggering an excessive immune response that leads to widespread inflammation and tissue damage. The condition was first identified in children in 1978 and gained public attention in the early 1980s due to its association with tampon use.

Pathophysiology

The pathophysiology of TSS involves the entry of bacteria into the bloodstream, where they release toxins. These toxins bypass normal antigen processing and directly stimulate a large proportion of T-cells, leading to a massive release of cytokines. This cytokine storm results in fever, rash, hypotension, and multi-organ failure.

Clinical Presentation

Patients with TSS typically present with sudden onset of high fever, hypotension, and a diffuse macular rash resembling a sunburn. Other symptoms may include vomiting, diarrhea, myalgia, and confusion. Desquamation, particularly of the palms and soles, may occur 1-2 weeks after the onset of symptoms.

Diagnosis

Diagnosis of TSS is primarily clinical, based on the characteristic signs and symptoms. Laboratory tests may show elevated white blood cell count, elevated liver enzymes, and renal impairment. Blood cultures may be positive for Staphylococcus aureus or Streptococcus pyogenes, but negative cultures do not rule out TSS.

Treatment

Treatment of TSS involves supportive care, including fluid resuscitation and vasopressors to manage shock. Antibiotic therapy is crucial and typically includes a combination of clindamycin and vancomycin. In cases associated with tampon use, removal of the tampon is essential. Surgical intervention may be necessary to remove the source of infection, such as in cases of necrotizing fasciitis.

Prognosis

With prompt recognition and treatment, the prognosis for TSS is generally good, although it can be fatal if not treated quickly. Mortality rates have decreased significantly with improved medical care and awareness.

Prevention

Preventive measures include proper tampon use, such as changing tampons frequently and using the lowest absorbency necessary. Awareness of the symptoms of TSS is important for early detection and treatment.

Also see

• Staphylococcus aureus
• Streptococcus pyogenes
• Sepsis
• Cytokine storm