Toxic shock syndrome arises from bacterial infection to cause acute life-threatening illness.
Highly absorbent tampons, frequent use, and extended wear increase risk of menstrual TSS in women.
Severe illness with high fever, rash, low blood pressure, multiple organ failure, and peeling skin usually appearing 1 to 2 weeks later.
TSS is caused by two types of bacteria:
Staphylococcus aureus
Streptococcus pyogenes
group A Streptococcus (GAS) is a gram-positive organism causing soft tissue infections. Risk factors include diabetes, alcoholism, varicella infections, and surgical procedures.
Epidemiology
Population studies estimate 1.5 to 5.2 cases of invasive GAS infection per 100000 individuals in year, with 8% to 14% develops TSS.
No menstrual staphylococcal TSS incidence surpasses menstrual STSS after hyper absorbable tampons removed, with estimated 1 in 100,000 cases.
TSS seen in all races, mostly in North America and Europe; STSS mainly affects women using tampons.
STSS cases more prevalent in individuals over 60 years old than under 10 years old.
Anatomy
Pathophysiology
Intoxication by Staphylococcus aureus exotoxins, such as TSST-1 and Staphylococcal enterotoxin B responsible for TSS.
Filamentous M protein resists phagocytes on cell membrane. Common types 1, 3, 12, 28 found in patients with shock.
Colonization or infection with specific S aureus and GAS strains leads to toxin production causing systemic manifestations of TSS in individuals without protective antibodies.
Etiology
STSS risk factors include tampon use, vaginal colonization with toxin-producing S aureus, and lacking serum antibodies.
Streptococci entry point unknown in nearly half of cases. Infection usually starts at small local injury site.
Genetics
Prognostic Factors
Streptococcal TSS has mortality rates of 30% to 70% with a high morbidity rate, that causes surgical procedures in some cases. The case fatality rates for menstrual-related STSS have declined from 5.5% in 1980 to 1.8%.
Clinical History
TSS found in menstruating females aged between 15 to 25 years old.
Children and adults can also develop TSS from skin infections and surgical wounds.
Physical Examination
Skin assessment
Musculoskeletal examination
Neurological Examination
Mucous membrane
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Initial Symptoms includes sudden onset of high fever, hypotension, malaise and fatigue.
Rapidly appearing red rash can spread across body, like sunburn occurs within hours.
Differential Diagnoses
Sepsis
Kawasaki Disease
Scarlet Fever
Rocky Mountain Spotted Fever
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
pyogenes still vulnerable to beta-lactam antibiotics and effective against infections.
GAS infections resistant to penicillin have high mortality rates and cause extensive morbidity.
Beta-lactam antibiotics like penicillin show the best result against fast-growing bacteria, especially in early infection or mild cases.
Increased gas concentrations lower beta-lactam antibiotic effectiveness as bacterial growth slows.
Clindamycin effectively fights GAS infection regardless of inoculum size or growth stage.
Patients with TSS need critical care and should be transferred to a capable intensive care unit.
TSS leads to severe low blood pressure and leaks in capillaries, may require high IV fluid intake.
Norepinephrine, with or without dobutamine, is more effective than dopamine or epinephrine in splanchnic perfusion.
Aggressive exploration and debridement for suspected deep-seeded pyogenic infection are surgical emergencies. Small incision with muscle and fascia visualization helps in early diagnosis of necrotizing fasciitis.
Surgical debridement for extensive infections is necessary, may require re-exploration to confirm complete removal.
use-of-phases-in-managing-toxic-shock-syndrome
In the diagnosis phase, evaluation of symptoms such as fever, hypotension, rash, and medical history to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of antibiotics and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.
Toxic shock syndrome arises from bacterial infection to cause acute life-threatening illness.
Highly absorbent tampons, frequent use, and extended wear increase risk of menstrual TSS in women.
Severe illness with high fever, rash, low blood pressure, multiple organ failure, and peeling skin usually appearing 1 to 2 weeks later.
TSS is caused by two types of bacteria:
Staphylococcus aureus
Streptococcus pyogenes
group A Streptococcus (GAS) is a gram-positive organism causing soft tissue infections. Risk factors include diabetes, alcoholism, varicella infections, and surgical procedures.
Population studies estimate 1.5 to 5.2 cases of invasive GAS infection per 100000 individuals in year, with 8% to 14% develops TSS.
No menstrual staphylococcal TSS incidence surpasses menstrual STSS after hyper absorbable tampons removed, with estimated 1 in 100,000 cases.
TSS seen in all races, mostly in North America and Europe; STSS mainly affects women using tampons.
STSS cases more prevalent in individuals over 60 years old than under 10 years old.
Intoxication by Staphylococcus aureus exotoxins, such as TSST-1 and Staphylococcal enterotoxin B responsible for TSS.
Filamentous M protein resists phagocytes on cell membrane. Common types 1, 3, 12, 28 found in patients with shock.
Colonization or infection with specific S aureus and GAS strains leads to toxin production causing systemic manifestations of TSS in individuals without protective antibodies.
STSS risk factors include tampon use, vaginal colonization with toxin-producing S aureus, and lacking serum antibodies.
Streptococci entry point unknown in nearly half of cases. Infection usually starts at small local injury site.
Streptococcal TSS has mortality rates of 30% to 70% with a high morbidity rate, that causes surgical procedures in some cases. The case fatality rates for menstrual-related STSS have declined from 5.5% in 1980 to 1.8%.
TSS found in menstruating females aged between 15 to 25 years old.
Children and adults can also develop TSS from skin infections and surgical wounds.
Skin assessment
Musculoskeletal examination
Neurological Examination
Mucous membrane
Initial Symptoms includes sudden onset of high fever, hypotension, malaise and fatigue.
Rapidly appearing red rash can spread across body, like sunburn occurs within hours.
Sepsis
Kawasaki Disease
Scarlet Fever
Rocky Mountain Spotted Fever
pyogenes still vulnerable to beta-lactam antibiotics and effective against infections.
GAS infections resistant to penicillin have high mortality rates and cause extensive morbidity.
Beta-lactam antibiotics like penicillin show the best result against fast-growing bacteria, especially in early infection or mild cases.
Increased gas concentrations lower beta-lactam antibiotic effectiveness as bacterial growth slows.
Clindamycin effectively fights GAS infection regardless of inoculum size or growth stage.
Patients with TSS need critical care and should be transferred to a capable intensive care unit.
TSS leads to severe low blood pressure and leaks in capillaries, may require high IV fluid intake.
Norepinephrine, with or without dobutamine, is more effective than dopamine or epinephrine in splanchnic perfusion.
Infectious Disease
Proper treatment of wounds/cuts should be done within time to avoid further damage.
Patients should follow good hygiene practices to avoid spreading the infection.
Patient should also adapt good personal hygiene and use of menstrual products including menstrual cups.
Proper education and awareness about TSS should be provided and its related causes, and how to stop it with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Infectious Disease
Clindamycin:
It inhibits bacteria that blocks peptidyl tRNA dissociation from ribosomes.
It is potent against gram-positive and Enterococcus, effective for septicemia and skin infections treatment.
Tedizolid:
It is oxazolidione antibiotic binds to bacterial ribosome 50S subunit.
Dalbavancin:
It is a lipoglycopeptide antibiotic that disrupts cell wall synthesis to block peptide binding.
Infectious Disease
Aggressive exploration and debridement for suspected deep-seeded pyogenic infection are surgical emergencies. Small incision with muscle and fascia visualization helps in early diagnosis of necrotizing fasciitis.
Surgical debridement for extensive infections is necessary, may require re-exploration to confirm complete removal.
Dermatology, General
In the diagnosis phase, evaluation of symptoms such as fever, hypotension, rash, and medical history to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of antibiotics and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.
Toxic shock syndrome arises from bacterial infection to cause acute life-threatening illness.
Highly absorbent tampons, frequent use, and extended wear increase risk of menstrual TSS in women.
Severe illness with high fever, rash, low blood pressure, multiple organ failure, and peeling skin usually appearing 1 to 2 weeks later.
TSS is caused by two types of bacteria:
Staphylococcus aureus
Streptococcus pyogenes
group A Streptococcus (GAS) is a gram-positive organism causing soft tissue infections. Risk factors include diabetes, alcoholism, varicella infections, and surgical procedures.
Population studies estimate 1.5 to 5.2 cases of invasive GAS infection per 100000 individuals in year, with 8% to 14% develops TSS.
No menstrual staphylococcal TSS incidence surpasses menstrual STSS after hyper absorbable tampons removed, with estimated 1 in 100,000 cases.
TSS seen in all races, mostly in North America and Europe; STSS mainly affects women using tampons.
STSS cases more prevalent in individuals over 60 years old than under 10 years old.
Intoxication by Staphylococcus aureus exotoxins, such as TSST-1 and Staphylococcal enterotoxin B responsible for TSS.
Filamentous M protein resists phagocytes on cell membrane. Common types 1, 3, 12, 28 found in patients with shock.
Colonization or infection with specific S aureus and GAS strains leads to toxin production causing systemic manifestations of TSS in individuals without protective antibodies.
STSS risk factors include tampon use, vaginal colonization with toxin-producing S aureus, and lacking serum antibodies.
Streptococci entry point unknown in nearly half of cases. Infection usually starts at small local injury site.
Streptococcal TSS has mortality rates of 30% to 70% with a high morbidity rate, that causes surgical procedures in some cases. The case fatality rates for menstrual-related STSS have declined from 5.5% in 1980 to 1.8%.
TSS found in menstruating females aged between 15 to 25 years old.
Children and adults can also develop TSS from skin infections and surgical wounds.
Skin assessment
Musculoskeletal examination
Neurological Examination
Mucous membrane
Initial Symptoms includes sudden onset of high fever, hypotension, malaise and fatigue.
Rapidly appearing red rash can spread across body, like sunburn occurs within hours.
Sepsis
Kawasaki Disease
Scarlet Fever
Rocky Mountain Spotted Fever
pyogenes still vulnerable to beta-lactam antibiotics and effective against infections.
GAS infections resistant to penicillin have high mortality rates and cause extensive morbidity.
Beta-lactam antibiotics like penicillin show the best result against fast-growing bacteria, especially in early infection or mild cases.
Increased gas concentrations lower beta-lactam antibiotic effectiveness as bacterial growth slows.
Clindamycin effectively fights GAS infection regardless of inoculum size or growth stage.
Patients with TSS need critical care and should be transferred to a capable intensive care unit.
TSS leads to severe low blood pressure and leaks in capillaries, may require high IV fluid intake.
Norepinephrine, with or without dobutamine, is more effective than dopamine or epinephrine in splanchnic perfusion.
Infectious Disease
Proper treatment of wounds/cuts should be done within time to avoid further damage.
Patients should follow good hygiene practices to avoid spreading the infection.
Patient should also adapt good personal hygiene and use of menstrual products including menstrual cups.
Proper education and awareness about TSS should be provided and its related causes, and how to stop it with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Infectious Disease
Clindamycin:
It inhibits bacteria that blocks peptidyl tRNA dissociation from ribosomes.
It is potent against gram-positive and Enterococcus, effective for septicemia and skin infections treatment.
Tedizolid:
It is oxazolidione antibiotic binds to bacterial ribosome 50S subunit.
Dalbavancin:
It is a lipoglycopeptide antibiotic that disrupts cell wall synthesis to block peptide binding.
Infectious Disease
Aggressive exploration and debridement for suspected deep-seeded pyogenic infection are surgical emergencies. Small incision with muscle and fascia visualization helps in early diagnosis of necrotizing fasciitis.
Surgical debridement for extensive infections is necessary, may require re-exploration to confirm complete removal.
Dermatology, General
In the diagnosis phase, evaluation of symptoms such as fever, hypotension, rash, and medical history to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of antibiotics and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.
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