Toxic Shock Syndrome

Key points
Condition results in a severe acute illness with fever, rash, low blood pressure, tissue injury and shock which requires immediate medical attention.
Condition can occur menstrually (affecting women) or non-menstrually (affecting both men and women).
Condition is caused primarily by strains of the bacteria Staphylococcus aureus and Streptococcus pyogenes.

Toxic shock syndrome is an uncommon but severe acute illness with fever, widespread red rash accompanied by involvement of other body organs, which requires prompt medical treatment. Toxic shock syndrome has been linked to the prolonged use of highly absorbent tampons in menstruating women, as well as the use of contraceptive diaphragms and vaginal sponges (by women), as well as Wound infections. It is caused by strains of the bacteria staphylococcus aureus and streptococcus pyogenes. Both menstrual and non-menstrual forms of toxic shock syndrome produce fever, rash, low blood pressure, tissue injury and shock.

The majority of menstrual toxic shock syndrome cases are associated with the wearing of tampons, however the condition is now relatively rare, as most adults have developed protective antibodies. Women who have had toxic shock syndrome are at greatest risk as the recurrence rate is reported to be between 30-40%. Non-menstrual Toxic shock syndrome occurs in males and females of all age groups, usually associated with infections. Strangely enough, it has been found that the majority of cases are in healthy persons aged between 20 to 50 years, despite the fact that those most susceptible to staphylococcal and streptococcal infections are infants and young children, elderly, and immunocompromised individuals.

Toxic shock syndrome starts from a staphylococcal infection. In addition, toxic shock syndrome may occur as a complication of other infections such as pneumonia, osteomyelitis, sinusitis, and skin wounds (surgical or burns), where staphylococcus aureus infections may develop. In these situations the patient has increased susceptibility to developing toxic shock syndrome. Other predisposing factors are if the patient has recently had flu or the chickenpox.

Fever, rash, low blood pressure, and multiple organ involvement are seen as the hallmarks of toxic shock syndrome. Shedding of the skin in large sheets, especially of the palms and soles, is usually seen 1-2 weeks after the onset of illness. Individuals may experience symptoms and signs differently.

Differential Diagnosis (Other conditions with similar appearance)
Acanthosis nigricans
Kawasaki disease
Scarlet Fever
Staphylococcal Scaled Skin Syndrome

Diagnosis
Key Points
The CDC has created a criteria checklist consisting of five symptoms that would denote toxic shock syndrome.
In addition, there are other diagnostic tests that can be performed.

The CDC has created a criteria checklist consisting of five symptoms that would denote toxic shock syndrome: a temperature greater than or equal to 102° F, low blood pressure, widespread red flat rash, shedding of skin especially on palms or soles 1-2 weeks after onset of illness, and abnormalities in three of the following organ systems — gastrointestinal (vomiting or diarrhea), muscular (severe muscle pain), hepatic (decreased liver function), renal (raised Urea or creatinine levels), hematologic (bruising due to low blood platelet count ), central nervous system (disorientation or confusion), and mucous membranes (red eyes, mouth or vagina from increased blood flow.) Toxic shock syndrome is confirmed if all five criteria are noted, but even four of the five is a probable case. In addition to meeting the criteria, other diagnostic tests may include blood cultures, blood tests, and urine tests.

Treatment
Key points
Antibiotics and hospitalization are the primary form of treatment.
Additional treatments are mostly to combat symptoms of toxic shock syndrome.
Prevention and early diagnosis can prevent prolonged detrimental effects.

Treatment of toxic shock syndrome requires hospitalization and intravenous antibiotics. Other treatments are mostly to combat the symptoms of toxic shock syndrome including intravenous fluids to treat shock and prevent organ damage, cardiac medications for patients with very low blood pressure, dialysis in patients who develop renal failure, administration of blood products, deep surgical cleaning of an infected wound, and oxygen and mechanical ventilation to assist with breathing.

Prevention is also a key to treatment and avoidance of toxic shock syndrome. Women who have had toxic shock syndrome should avoid using tampons during menstruation as reinfection may occur. The use of diaphragms and vaginal sponges may also increase the risk of Toxic shock syndrome. Prompt and thorough wound care will help to avoid toxic shock syndrome. Early diagnosis and appropriate treatment prevents progression of the disease and possible complications such as heart problems, acute renal failure, adult respiratory distress syndrome and disseminated intravascular coagulation.