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Toxic shock syndrome
Other namesStaphylococcal scarlet fever;[1] bacterial toxic shock syndrome[2]
Toxic shock syndrome toxin-1 protein from staphylococcus
Medical specialtyInfectious disease
SymptomsFever, rash, skin peeling, low blood pressure[3]
Usual onsetRapid[3]
TypesStaphylococcal (menstrual and nonmenstrual), streptococcal[3]
CausesStreptococcus pyogenes, Staphylococcus aureus, others[3][4]
Risk factorsVery absorbent tampons, skin lesions in young children[3]
Diagnostic methodBased on symptoms[3]
Differential diagnosisSeptic shock, Kawasaki's disease, Stevens–Johnson syndrome, scarlet fever[5]
TreatmentAntibiotics, incision and drainage of any abscesses, intravenous immunoglobulin[3]
PrognosisRisk of death: ~50% (streptococcal), ~5% (staphylococcal)[3]
Frequency3 per 100,000 per year (developed world)[3]

Toxic shock syndrome (TSS) is a condition caused by bacterial toxins.[3] Symptoms may include fever, rash, skin peeling, and low blood pressure.[3] There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelitis, necrotising fasciitis, or pneumonia.[3]

TSS is typically caused by bacteria of the Streptococcus pyogenes or Staphylococcus aureus type, though others may also be involved.[3][4] Streptococcal toxic shock syndrome is sometimes referred to as toxic-shock-like syndrome (TSLS).[3] The underlying mechanism involves the production of superantigens during an invasive streptococcus infection or a localized staphylococcus infection.[3] Risk factors for the staphylococcal type include the use of very absorbent tampons, and skin lesions in young children.[3] Diagnosis is typically based on symptoms.[3]

Treatment includes intravenous fluids, antibiotics, incision and drainage of any abscesses, and possibly intravenous immunoglobulin.[3][6] 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.[3] Some recommend delaying surgical debridement.[3] The overall risk of death is about 50% in streptococcal disease, and 5% in staphylococcal disease.[3] Death may occur within 2 days.[3]

In the United States streptococcal TSS occurs in about 3 per 100,000 per year, and staphylococcal TSS in about 0.5 per 100,000 per year.[3] The condition is more common in the developing world.[3] It was first described in 1927.[3] Due to the association with very absorbent tampons, these products were removed from sale.[3]

References

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  1. "Toxic shock syndrome | DermNet". dermnetnz.org. Archived from the original on 24 November 2022. Retrieved 21 December 2022. {{cite web}}: More than one of |archivedate= and |archive-date= specified (help); More than one of |archiveurl= and |archive-url= specified (help)
  2. RESERVED, INSERM US14-- ALL RIGHTS. "Orphanet: Bacterial toxic shock syndrome". www.orpha.net. Archived from the original on 29 November 2023. Retrieved 15 February 2024. {{cite web}}: More than one of |archivedate= and |archive-date= specified (help); More than one of |archiveurl= and |archive-url= specified (help)CS1 maint: numeric names: authors list (link)
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 Low, DE (July 2013). "Toxic shock syndrome: major advances in pathogenesis, but not treatment". Critical Care Clinics. 29 (3): 651–75. doi:10.1016/j.ccc.2013.03.012. PMID 23830657.
  4. 4.0 4.1 Gottlieb, Michael; Long, Brit; Koyfman, Alex (June 2018). "The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature". The Journal of Emergency Medicine. 54 (6): 807–814. doi:10.1016/j.jemermed.2017.12.048. PMID 29366615.
  5. Ferri, Fred F. (2010). Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia: Elsevier/Mosby. p. Chapter T. ISBN 978-0323076999.
  6. Wilkins, Amanda L.; Steer, Andrew C.; Smeesters, Pierre R.; Curtis, Nigel (2017). "Toxic shock syndrome – the seven Rs of management and treatment". Journal of Infection. 74: S147–S152. doi:10.1016/S0163-4453(17)30206-2. PMID 28646955.