Toxic shock syndrome (TSS)

Background

• 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)