Toxic shock syndrome (TSS)


  • Toxin-producing strains of staphylococci and streptococci
  • Association of TSS with tampon use
  • 75% due to Toxic shock syndrome toxin-1 (TSST-1)
  • 25% enterotoxin B C
    • Both TSS-1 and enterotoxins are super-antigen
    • Massive stimulation of T-cells with release of cytokines
  • Most patients NOT immunosuppressed
  • Streptococcal shock synd. higher mortality (30%)
  • Usually younger (<35yo)
  • Menstruation or recent surgery
  • NB recent prior antibiotic (ab)use

Sudden onset of

Fever (>38.9°C)

↓BP (<90mmHg in adult)

Rash (generalised erythematous)

Multi-organ disease

  • Vom ± diarrhoea
  • Arthralgia, Myalgia (↑CK)
  • Confusion
  • Irritation of mucous membranes
  • Renal dysfunction (creat X2 normal)
  • Hepatitis (LFT or Bili x2 normal)
  • Thrombocytopaenia (<100x106 or DIC)
  • ARDS (Pulm Infilt on CXR, ↓PaO2, no LVF)


  • Bloods above, Negative serology for leptospira or measles

Content by Dr Íomhar O' Sullivan 12/02/2009.12/02/2010. Last review Dr ÍOS 10/06/21.