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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.

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Section 3. Summaries of Infectious Diseases

Toxic Shock Syndrome

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Toxic shock syndrome (TSS) may be caused by toxin-producing Staphylococcus aureus or Streptococcus pyogenes (group A streptococci). Both organisms cause an acute illness characterized by fever, generalized erythroderma, rapid-onset hypotension, and symptoms of multisystem organ involvement that can include profuse watery diarrhea, vomiting, conjunctival injection, and severe myalgias (see Tables 3.64, p 662, and 3.65, p 663). Evidence of local soft tissue infection (eg, cellulitis, abscess, myositis, or necrotizing fasciitis) associated with severe increasing pain is common with S pyogenes-mediated TSS. Staphylococcus aureus-mediated TSS commonly occurs in menstruating females using tampons but also occurs in males and females with focal S aureus infection (eg, abscess, sinusitis). Both forms of TSS may occur without a readily identifiable focus of infection. Both forms of TSS also may be associated with invasive infections, such as pneumonia, osteomyelitis, bacteremia, pyarthrosis, or endocarditis. Patients with S aureus-mediated TSS, especially menses associated, are at risk of a recurrent episode of TSS. Toxic shock can be confused with many infectious and noninfectious causes of fever with mucocutaneous manifestations.


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  		Table 3.64. Staphylococcal Toxic Shock Syndrome: Clinical Case Definition1

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  		Table 3.65. Streptococcal Toxic Shock Syndrome: Clinical Case Definition1


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ETIOLOGY: Staphylococcus aureus-mediated TSS usually is caused by strains producing toxic-shock syndrome toxin-1 (TSST-1) or possibly other related staphylococcal enterotoxins. Most cases of S pyogenes-mediated TSS are caused by strains producing at least 1 of several different pyrogenic exotoxins. These toxins act as superantigens that stimulate production of tumor necrosis factor and other mediators that cause capillary . . . [Go to Full Text]


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