Toxic shock syndrome
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Toxic shock syndrome (TSS) is a condition caused by bacterial toxins.[1] Symptoms may include fever, rash, skin peeling, and low blood pressure.[1] There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelitis, necrotising fasciitis, or pneumonia.[1]
Toxic shock syndrome | |
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Toxic shock syndrome toxin-1 protein from staphylococcus | |
Specialty | Infectious disease |
Symptoms | Fever, rash, skin peeling, low blood pressure[1] |
Complications | Shock, kidney failure[2] |
Usual onset | Rapid[1] |
Types | Staphylococcal (menstrual and nonmenstrual), streptococcal[1] |
Causes | Streptococcus pyogenes, Staphylococcus aureus, others[1][3] |
Risk factors | Very absorbent tampons, skin lesions in young children[1] |
Diagnostic method | Based on symptoms[1] |
Differential diagnosis | Septic shock, Kawasaki's disease, Stevens–Johnson syndrome, scarlet fever[4] |
Treatment | Antibiotics, incision and drainage of any abscesses, intravenous immunoglobulin[1] |
Prognosis | Risk of death: ~50% (streptococcal), ~5% (staphylococcal)[1] |
Frequency | 3 per 100,000[definition needed] per year (developed world)[1] |
TSS is typically caused by bacteria of the Streptococcus pyogenes or Staphylococcus aureus type, though others may also be involved.[1][3] Streptococcal toxic shock syndrome is sometimes referred to as toxic-shock-like syndrome (TSLS).[1] The underlying mechanism involves the production of superantigens during an invasive streptococcus infection or a localized staphylococcus infection.[1] Risk factors for the staphylococcal type include the use of very absorbent tampons, skin lesions in young children characterized by fever, low blood pressure, rash, vomiting and/or diarrhea, and multiorgan failure.[1][5][6] Diagnosis is typically based on symptoms.[1]
Treatment includes intravenous fluids, antibiotics, incision and drainage of any abscesses, and possibly intravenous immunoglobulin.[1][7] 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.[1] Some recommend delaying surgical debridement.[1] The overall risk of death is about 50% in streptococcal disease, and 5% in staphylococcal disease.[1] Death may occur within 2 days.[1]
In the United States, streptococcal TSS occurs in about 3 per 100,000[definition needed] per year, and staphylococcal TSS in about 0.5 per 100,000[definition needed] per year.[1] The condition is more common in the developing world.[1] It was first described in 1927.[1] Due to the association with very absorbent tampons, these products were removed from sale.[1]