Toxic shock syndrome

Toxic shock syndrome
Toxic shock syndrome toxin-1 protein from staphylococcus
Specialty	Infectious disease
Symptoms	Fever, rash, skin peeling, low blood pressure[1]
Complications	Shock, kidney failure[2]
Usual onset	Rapid[1]
Types	Staphylococcal (menstrual and nonmenstrual), streptococcal[1]
Causes	Streptococcus pyogenes, Staphylococcus aureus, others[1][3]
Risk factors	Very absorbent tampons, skin lesions in young children[1]
Diagnostic method	Based on symptoms[1]
Differential diagnosis	Septic shock, Kawasaki's disease, Stevens–Johnson syndrome, scarlet fever[4]
Treatment	Antibiotics, incision and drainage of any abscesses, intravenous immunoglobulin[1]
Prognosis	Risk of death: ~50% (streptococcal), ~5% (staphylococcal)[1]
Frequency	Staphylococcal: 0.3 to 0.5 cases per 100,000 population Streptococcal: 2 to 4 cases per 100,000 population

Toxic shock syndrome (TSS) is a condition caused by bacterial toxins.^[1] Symptoms may include fever, rash, skin peeling, and low blood pressure.^[1] There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelitis, necrotising fasciitis, or pneumonia.^[1]

TSS is typically caused by bacteria of the Streptococcus pyogenes or Staphylococcus aureus type, though others may also be involved.^[1][3] Streptococcal toxic shock syndrome is sometimes referred to as toxic-shock-like syndrome (TSLS).^[1] The underlying mechanism involves the production of superantigens during an invasive streptococcus infection or a localized staphylococcus infection.^[1] Risk factors for the staphylococcal type include the use of very absorbent tampons, skin lesions in young children characterized by fever, low blood pressure, rash, vomiting and/or diarrhea, and multiorgan failure.^[1][5][6] Diagnosis is typically based on symptoms.^[1]

Treatment includes intravenous fluids, antibiotics, incision and drainage of any abscesses, and possibly intravenous immunoglobulin.^[1][7] The need for rapid removal of infected tissue via surgery in those with a streptococcal cause, while commonly recommended, is poorly supported by the evidence.^[1] Some recommend delaying surgical debridement.^[1] The overall risk of death is about 50% in streptococcal disease, and 5% in staphylococcal disease.^[1] Death may occur within 2 days.^[1]

In the United States, the incidence of menstrual staphylococcal TSS declined sharply in the 1990s, while both menstrual and nonmenstrual cases have stabilized at about 0.3 to 0.5 cases per 100,000 population.^[1] Streptococcal TSS (STSS) saw a significant rise in the mid-1980s and has since remained stable at 2 to 4 cases per 100,000 population.^[1] In the developing world, the number of cases is usually on the higher extreme.^[1] TSS was first described in 1927.^[1] It got associated with very absorbent tampons that were removed from sale soon after.^[1]