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Ugeskrift For Laeger May 2020Toxic shock syndrome is a rare, life-threatening disease caused by Staphylococcus aureus or Streptococcus pyogenes. These bacteria are able to produce superantigens,... (Review)
Review
Toxic shock syndrome is a rare, life-threatening disease caused by Staphylococcus aureus or Streptococcus pyogenes. These bacteria are able to produce superantigens, which bypass normal antigen presentation and cause a clonal T-cell expansion and uncontrolled release of pro-inflammatory mediators, which results in severe multiple organ failure. Despite high morbidity and mortality, the disease is underdiagnosed. In order to reduce morbidity and mortality early diagnosis and treatment with a combination of beta-lactam antibiotics, clindamycin and intravenous immunoglobulin is essential, which is underlined in this review.
Topics: Humans; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Superantigens
PubMed: 32400378
DOI: No ID Found -
The Journal of Infection Jun 2017Staphylococcal and streptococcal toxic shock syndrome (TSS) are associated with significant morbidity and mortality. There has been considerable progress in... (Review)
Review
Staphylococcal and streptococcal toxic shock syndrome (TSS) are associated with significant morbidity and mortality. There has been considerable progress in understanding the pathophysiology and delineating optimal management and treatment. This article reviews the management of TSS, outlining the 'Seven Rs of Managing and Treating TSS': Recognition, Resuscitation, Removal of source of infection, Rational choice of antibiotics, Role of adjunctive treatment (clindamycin and intravenous immunoglobulin), Review of progress and Reduce risk of secondary cases in close contacts.
Topics: Disease Management; Humans; Shock, Septic; Staphylococcal Infections; Streptococcal Infections
PubMed: 28646955
DOI: 10.1016/S0163-4453(17)30206-2 -
The Journal of Emergency Medicine Jun 2018Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. (Review)
Review
BACKGROUND
Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately.
OBJECTIVE
This review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS.
DISCUSSION
The most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid.
CONCLUSION
TSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.
Topics: Anti-Bacterial Agents; Emergency Service, Hospital; Humans; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes
PubMed: 29366615
DOI: 10.1016/j.jemermed.2017.12.048 -
Indian Journal of Pediatrics Apr 2023
Topics: Humans; Shock, Septic; Staphylococcal Infections
PubMed: 36635581
DOI: 10.1007/s12098-023-04478-z -
International Journal of Dermatology Apr 1982
Review
Topics: Adolescent; Adult; Bacterial Toxins; Child; Diagnosis, Differential; Enterotoxins; Exotoxins; Female; Humans; Male; Menstruation; Middle Aged; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens; Syndrome; Tampons, Surgical
PubMed: 7044996
DOI: 10.1111/j.1365-4362.1982.tb02052.x -
The Western Journal of Medicine Nov 1981
Review
Topics: Adolescent; Anti-Bacterial Agents; Child; Drug Resistance, Microbial; Female; Humans; Male; Menstruation; Recurrence; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus
PubMed: 7041429
DOI: No ID Found -
Postgraduate Medicine Jan 1983Toxic shock syndrome (TSS) is an exotoxin-mediated illness that occurs primarily in young menstruating women who use tampons. The syndrome ranges from a potentially... (Review)
Review
Toxic shock syndrome (TSS) is an exotoxin-mediated illness that occurs primarily in young menstruating women who use tampons. The syndrome ranges from a potentially fatal disease characterized by hypotension and failure in multiple organ systems to a less severe condition commonly misdiagnosed as a nonspecific viral illness or gastroenteritis. Physicians should recognize that an exanthematous, febrile illness that recurs during menstruation or that occurs primarily in the postoperative or postpartum period and in association with staphylococcal infections may be TSS even in the absence of requisite diagnostic criteria. Unless TSS can be excluded with reasonable certainty, appropriate cultures should be obtained, with treatment initiated presumptively. In all menstrual cases, women should be advised to avoid tampon use indefinitely.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Male; Menstrual Hygiene Products; Menstruation; Recurrence; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Syndrome
PubMed: 6336841
DOI: 10.1080/00325481.1983.11698331 -
Boletin de La Asociacion Medica de... Dec 1982
Review
Topics: Adult; Bacteriophage Typing; Female; Humans; Middle Aged; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus
PubMed: 6086117
DOI: No ID Found -
Ugeskrift For Laeger May 2021Toxic shock syndrome is a potentially deadly toxin-mediated disease in which quick diagnosis is imperative for treatment and prognosis. This is a case report of a...
Toxic shock syndrome is a potentially deadly toxin-mediated disease in which quick diagnosis is imperative for treatment and prognosis. This is a case report of a 21-year-old woman admitted with high fever, confusion, petechial rash and hypotension. During catherisation a tampon was found, and from a vaginal swab Staphylococcus aureus was grown. The patient was hospitalised for eight days, two of which were at the intensive care unit for norepinephrine infusion for hypotension. She was successfully treated with the antibiotics dicloxacillin and clindamycin.
Topics: Adult; Anti-Bacterial Agents; Clindamycin; Female; Humans; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Young Adult
PubMed: 33998442
DOI: No ID Found -
Pediatric Emergency Care Mar 2020Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has...
BACKGROUND
Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined.
CASE
A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise. She was found to be tachycardic and hypotensive. Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. Recent tampon usage with menstruation was reported, and a pelvic examination revealed purulent vaginal discharge. The patient was transferred to a pediatric intensive care unit for antibiotic and vasopressor therapy. Vaginal swabs later tested positive for Staphylococcus aureus and TSS toxin-1.
CONCLUSIONS
Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.
Topics: Adolescent; Anti-Bacterial Agents; Bacterial Toxins; Enterotoxins; Female; Humans; Menstrual Hygiene Products; Menstruation; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens
PubMed: 29040243
DOI: 10.1097/PEC.0000000000001310