Diseases

In general, after the history and physical, if the patient has low blood pressure and multiorgan involvement characterized by two of the above listed symptoms of organ dysfunction (renal, lung, liver, skin, or blood), the clinical diagnosis of TSS is made, according to CDC criteria. A confirmation of the diagnosis is done by isolation of one of the causative bacteria; the bacteria should be identified as capable of producing exotoxin that either is, or functions like, TSST-1.

It is possible to reduce the chances of developing TSS. Menstruating females should minimize use of items like tampons, diaphragms, and sponges. Tampons should be changed frequently, and superabsorbent tampons should be avoided. Anyone diagnosed with TTS has a higher risk of reinfection; women diagnosed with TSS should avoid tampon use in the future. Early treatment of wounds, especially deep wounds, can help prevent TSS.

Risk factors for TSS include a history of using superabsorbent tampons, surgical wounds, history of using a diaphragm or contraceptive sponge, having a localized infection deep in the skin, abortion, burns, and immunosuppression (for example, as seen with diabetes, chronic lung or heart disease, or in elderly patients).

TSS symptoms and signs a resemble those found in other infections; however, the most common symptoms of TSS are as follows:

• Fever higher than 38.9 C (102 F)
• Low blood pressure (about

The cause of toxic shock syndrome (TSS) is one of several closely related exotoxins secreted by bacteria that are infecting the person. The toxins activate T cells of the immune system to produce chemicals known as cytokines that subsequently cause shock and tissue damage. Although there are several closely related exotoxins, about 80% of individuals with TSS have an illness caused by TSST-1 or a similar exotoxin. Other exotoxins such as those produced by enterococci A, C, D, E, and H cause most of the remaining 20% of infections. M protein, a filamentous protein on the cell membrane of group A Streptococcus bacteria enhances the likelihood of the bacterial strain being more likely to cause disease. Bacterial strains that lack M protein are less lethal because M protein can protect bacteria from host immune defenses. In addition, M protein apparently enhances cell damage and inflammation caused by exotoxins.

Patients with TSS who are diagnosed early and given appropriate treatment often have a good prognosis. Early treatment can help prevent complications such as renal failure, respiratory failure, and coagulation disorders. However, the mortality (death) rate is about 5%-15%, and patients who develop complications have a poorer prognosis than those who do not. Patients who develop TSS are at risk for reinfection.

The treatment for TSS varies from patient to patient; however, the following treatments are fairly common. Patients with TSS usually will be treated with two or more of the following treatments:

• Intravenous fluids to treat shock
• IV antibiotics
• Deep surgical cleaning of any infected wounds
• Cardiac medications to help treat low blood pressure
• Oxygen and/or mechanical ventilation as needed
• Blood products if needed
• Dialysis for patients with kidney failure
• Hospitalization in an intensive-care unit

Toxic shock syndrome is a severe illness associated with group A Streptococcus (GAS or Streptococcus pyogenes); this bacterium produces a toxin termed TSS toxin-1 (TSST-1). TSS was first described in 1978 in children, but subsequent reports identified TSS outbreaks in women and were associated with tampon use. Although first thought to be additionally associated with menstruation, over the past years, less than half of TTS cases have been associated with menstruation. Although most cases of TTS occur in women, about 25% of nonmenstrual infections occur in men. TSS is also associated with Staphylococcus infections; some strains of these bacteria produce exotoxins very similar to TSST-1.