Toxic shock syndrome

An acute process caused by production of local exotoxins capable of diffusing into the tissues causing an exaggerated immunologic response with the development of a multi-system disease.

Bacteria that are capable of producing super antigens of of the pyrogenic family include Staphylococcus aureus in Streptococcus pyogenes.

Staphylococcus aureus is associated with classic toxic shock syndrome (TSS), while Streptococcus pyogenes is associated with the toxic-like shock syndrome (TSLS).

A significant colonization or infection with these organisms is required for the production of the antigens and development of the syndromes.

Rapid onset process with fever, hypotension, rash, nausea, vomiting, diarrhea, and potential for multi-system of organ failure.

It is associated with the elaboration of bacterial toxins causing cytokine release rather than direct bacterial infection.

Differential diagnosis includes sepsis from other bacterial organisms, staphylococcal scalded skin syndrome, Rocky Mountain spotted fever, meningococcemia, leptospirosis, viral syndromes, hyperthermia, insect associated allergic reactions, and drug reactions.

Menstrual form of TSS disease may occur after use of high absorbency tampons.

Presently, the non-menstrual forms are as common as the menstrual forms of TSS.

Non-menstrual forms of TSS may occur after surgical procedures, contraceptive diaphragms, peritoneal dialysis catheters, influenza, sinusitis, intravenous drug abuse, and burn wounds.

Toxic shock like syndrome (TSLS) is caused by Streptococcus pyogenes and the production of exotoxin A, however other types of streptococci and other exotoxins maybe responsible for the process.

TSLS most commonly occurs in healthy individuals between the ages of 20 and 50 years, but patients at the extremes of life and people with underlying comorbid processes are at greater risk.

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