Toxic shock syndrome (TSS)
Sudden onset of
Fever
Hypotension
Rash
Multi-organ disease
- Vom +/- diarrhoea
- Myalgia
- Confusion
- Renal dysfunction
- Hepatitis
- Thromocytopenia
- Toxin-producing strains of staphylococci and streptococci
- Association of TSS with tampon use
- 75% due to Toxic shock syndrome toxin-1 (TSST-1)
- 25% enterotoxin B C
- Both TSS-1 and enterotoxins are super-antigen
- Massive stimulation of T-cells with release of cytokines
- Most patients NOT immunosuppressed
- Streptococcal shock synd. higher mortality (30%)
- Usually younger (<35yo)
- Menstruation or recent surgery
- NB recent prior antibiotic (ab)use
Clinical
- Sudden onset
- Fever (>38.90)
- Myalgia / malaise (CK elevated)
- Arthralgia
- D&V
- Hypotension(SBP<90mmHg)
- Rash with desquamation (palms / soles)
- Irritation mucous membranes
- Clinical ARDS
- Acute onset of diffuse pulmonary infiltrates and hypoxaemia
- No cardiac failure
- Capillary leaking (generalized oedema, pleural or peritoneal effusions, hypoalbuminaemia)
Labs
- AST ALT (occasionally bilirubin) all raised
- Thromocytopenia (<100,000/ml) or DIC (esp. with Streptococcal Toxic Shock)
- Raised creat (and urea)
- Negative serology for leptospira or measles
