|  | Conditions & Treatments | Neurological Disorders

Toxic Shock Syndrome (TSS): Pathogenesis, Diagnosis, and Emergency Management

TSS is a toxin-mediated acute illness caused by Staphylococcus aureus (TSST-1, enterotoxins B/C) or Streptococcus pyogenes (SpeA, SpeB).

Diagnostic Criteria (CDC)

  • Fever ≥38.9°C (102°F)
  • Rash: Diffuse macular erythroderma (sunburn-like) → desquamation (1–2 weeks)
  • Hypotension (SBP ≤90 mmHg or orthostatic)
  • Multi-organ involvement (≥3): GI (vomiting/diarrhea), muscular (CK↑), mucous membrane (hyperemia), renal (Cr↑), hepatic (AST/ALT↑), hematologic (platelets↓), CNS (disorientation)

Risk Factors

  • Menstrual: High-absorbency tampons (polyester foam, carboxymethylcellulose) → S. aureus growth + toxin. Incidence dropped post-1980s Rely recall.
  • Non-menstrual: Surgical wounds, burns, skin infections, nasal packing, postpartum, IV drug use.
  • Immunocompromise.

Emergency Management

  1. ICU admission; hemodynamic monitoring.
  2. IV fluids (aggressive crystalloid resuscitation).
  3. IV antibiotics: Clindamycin (toxin synthesis inhibitor) + Vancomycin (MRSA coverage) or beta-lactam/beta-lactamase inhibitor.
  4. Source control: Remove tampon/foreign body; debride wound; drain abscess.
  5. Vasopressors (norepinephrine) for refractory shock.
  6. IVIG (adjunct; neutralizes superantigens).
  7. Renal replacement if AKI.

Prevention

  • Lowest absorbency tampon; change q4–8h; alternate with pads; avoid overnight.
  • Wound care hygiene.
  • No routine prophylaxis.

Mortality 5–15% with treatment; higher if delayed. Early recognition saves lives.

Neurological Disorders - Related Articles