Toxic Shock Syndrome
Basics
Description
Description
- Toxic shock syndrome (TSS) is a severe, acute life-threatening illness
- Etiologic organisms:
- Staphylococcus aureus, more common (TSS)
- Group A streptococcus (GAS), less common (streptococcal TSS or STSS)
- Both organisms produce toxins (SAgs) that upregulate immune response
- S. aureus produces structurally similar toxins:
- Toxic shock syndrome toxin (TSST-1)
- Enterotoxins A-E, I (SEA-E, SEI)
- GAS procedures M-protein, responsible for multiple virulence factors:
- Produces exotoxins (SPEs) that act as superantigens
- Creates complexes with fibrinogen that activate neutrophils and induce inflammatory response
- Interferes with complement pathway and avoids phagocytosis
- SAgs act as superantigens causing overwhelming immune response:
- Massive cytokine production (cytokine storm)
- Induce fever directly at the hypothalamus or indirectly via interleukin-1 (IL-1) and tumor necrosis factor (TNF) production
- Enhance delayed hypersensitivity
- Suppress neutrophil migration and immunoglobulin
- Directly act at tissue sites causing additional local reaction
- Massive vasodilation occurs
- Serum protein and fluid shifts leading to hypotension
Etiology
Etiology
- Initial cases described in young healthy menstruating females due to highly absorbent tampons
- Changes made in tampon composition to decrease incidence
- Approximately one-half of reported TSS cases are nonmenstrual:
- Surgical wounds
- Postpartum wound infections
- Mastitis
- Septorhinoplasty
- Sinusitis
- Osteomyelitis
- Arthritis
- Burns
- Nasal packing (nasal tampons)
- Cutaneous and subcutaneous lesions
- Nonmenstrual cases predominantly due to SEB and SEC producing S. aureus
- 30–50% of healthy adults and children carry S. aureus in the nasal vestibule, vagina, rectum and/or on the skin
- GAS infection often begin 24–72 hr at the site of monitor trauma, often without visible evidence on the skin site
- Despite increased incidence of methicillin-resistant S. aureus (MRSA) infections, a recent study reported MRSA only accounting for 7% of cases
- Association with severe influenza outbreaks and subsequent S. aureus coinfection
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Citation
Schaider, Jeffrey J., et al., editors. "Toxic Shock Syndrome." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307584/all/Toxic_Shock_Syndrome.
Toxic Shock Syndrome. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307584/all/Toxic_Shock_Syndrome. Accessed December 9, 2024.
Toxic Shock Syndrome. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307584/all/Toxic_Shock_Syndrome
Toxic Shock Syndrome [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307584/all/Toxic_Shock_Syndrome.
* Article titles in AMA citation format should be in sentence-case
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T1 - Toxic Shock Syndrome
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ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307584/all/Toxic_Shock_Syndrome
PB - Lippincott Williams & Wilkins
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DB - Emergency Central
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