Toxic shock syndrome (TSS) is an acute, noncontagious, toxin-mediated febrile illness caused by staphylococcal infection that rapidly leads to multiorgan system failure with serious morbidity and mortality. It may occur in men and children as well as women.
Toxic shock syndrome can also occur due to group A β-haemolytic streptococcal infection. This is more common in post-partum women but can occur post-surgery or miscarriage.
Staphylococcal toxic shock syndrome
Clinical features are:
- pyrexia (>39°C)
- hypotension (systolic <90mmHg)
- diarrhoea and vomiting
- muscle cramps and myalgia
- rash (diffuse macular erythroderma or 'sunburn')
- multiorgan dysfunction
- cutaneous desquamation (1–2 weeks into the recovery period)
- shock, adult respiratory distress syndrome, disseminated intravascular coagulation and renal failure can develop.
- about 18 confirmed cases are reported in the UK each year
- approximately half of cases are 'menstrual cases' (occurring during menstruation)
- non-menstrual cases may occur in the puerperium, following gynaecological surgery and septic miscarriage
- non-gynaecological cases occur mainly in burns and surgical patients.
The background rate of Staphylococcal aureus carriage is 15–40%. The nasopharynx is the principal site of carriage; other sites include the axillae, vagina and perineum. Contrary to common belief, tampons do not increase carriage rate.
TSS is caused by a strain of S. aureus that produces the toxins TSST-1 and enterotoxins A through E.
Three criteria are required to develop toxic shock syndrome:
- the patient is colonised or infected with S. aureus
- the bacteria produce TSS toxin (TSST)-1 or similar toxins
- the toxins have a route of entry into the circulatory system.
TSST-1 suppresses neutrophil chemotaxis, induces T-suppressor function and blocks the reticuloendothelial system.