Toxic shock syndrome: Treatment, symptoms, advice & help

About toxic shock syndrome (TSS)

Toxic shock syndrome is an uncommon but potentially devastating acute febrile illness caused by a bacterial toxin produced most commonly by Staphylococcus aureus and Streptococcus pyogenes.

Toxic shock syndrome: Incidence, age and sex

TSS is a rare condition that may occur at any age but has been recognized more frequently in teenage and young adult women. Individuals with focal infection caused by S.aureus, which can be occult, are at risk.

Signs & symptoms of toxic shock syndrome: Diagnosis

Patients with TSS usually have a prodrome of nausea and vomiting, sore throat, profuse watery diarrhoea and myalgia followed by (>38.8.C), hypertension, and a diffuse sunburn-like rash. The rash is most prominent on the trunk and usually is not pruritic. Conjunctival hyperemia without purulent exudates and pharyngeal hyperemia with a strawberry tongue are common. Hypotension leads to multiple organ system dysfunction. Desquamation of the palms, soles, fingers, and toes occurs 2 to 4 weeks after the onset of the illness. The diagnosis of TSS should be considered when a patient meets the definitions of TSS. Culture results must be negative for other etiologies except for S.aureus and negative serological test results for Rocky Mountain spotted fever, leptospirosis, and measles, as indicated. A focus of S. aureus infection should be aggressively sought.

Causes & prevention of toxic shock syndrome

The condition is caused by a bacterial toxin produced most commonly by Staphylococcus aureus and Streptococcus pyogenes. Toxins are thought to act as super-antigens that stimulate the host response.

Toxic shock syndrome: Complications

CNS abnormalities like obtundation and coma, hepatic abnormalities like elevated billirubin or transaminases, renal abnormalities like deranged renal functions and hematologic like low platelet count may occur. Multi-organ involvement with a high complication rate and death have also been reported.

Toxic shock syndrome: Treatment

Prompt intervention is mandatory for shock and multi-organ involvement. Drainage of the infected sites or removal of a potentially infectious medical device is imperative. Appropriate antibiotics, usually a penicillinase – resistant penicillin such as nafcillin, should be administered. Clindamycin also may be given to inhibit staphylococcal protein synthesis and thus toxin production. In severe cases, intravenous immunoglobulin may be administered to provide antitoxin antibodies and methylprednisolone to suppress cytokine production.