Toxic shock syndrome

Toxic shock syndrome occurs 2-3 days after beginning of menses in menstrual cases. There is high fever, vomiting, diarrhea, hypotension, delirium, and a sunburn-like rash. Patients may deteriorate within 48 hours to syncope, shock, renal failure, respiratory failure, and death (<3% mortality rate).

CASES/YEAR
780 (US); 15,600 (Global)
CATEGORY
Person-To-Person
AGENT TYPE
Bacteria
OTHER NAMES
TSS; Staphylococcal Toxic Shock Syndrome;
ACUITY
Acute-Severe
INCUBATION
2-3 days after beginning of menses in menstrual cases; [Harrisons, p. 447]
INITIAL SYMPTOMS
Sudden onset of high fever, vomiting, diarrhea, myalgia, hypotension, delirium, and a sunburn-like rash; [CCDM] Desquamation of rash on palms & soles 1-2 weeks after onset; Usually affects young & healthy people aged 20-50 years; [Cecil, 24th Ed, p. 2522]
PRECAUTIONS
Standard
COMMENTS
Patients may rapidly deteriorate within 48 hours to syncope, shock, renal failure, respiratory failure, and death (<3% mortality rate). [Merck Manual, p. 1608] The rash (erythroderma) is present during the acute phase and is followed by desquamation, especially of the palms and soles. Abnormal laboratory studies from organ injury include CPK (muscles), creatinine (kidneys), and AST or ALT (liver). Hyperemia of vaginal, oropharyngeal (strawberry tongue), or conjunctival tissues may be present. Platelets may be reduced. Some patients have altered mental status. The source of the toxogenic staphylococci is usually highly absorbent vaginal tampons, barrier contraceptives, or wound infections. Group A hemolytic streptococci can cause a similar syndrome. [CCDM, p. 579-80] TSS is one of the causes of fever and jaundice. [ID, p. 61] The case definition includes 1.) Fever; 2.) Hypotension; 3.) Rash & Desquamation (later); 4.) Multisystem involvement; and 5.) Negative laboratory evidence of Rocky Mountain spotted fever, leptospirosis, and measles. Tampon use is a historical risk factor, less common now with a change in manufacturing. [ABX Guide] The rash is a diffuse macular erythroderma. Desquamation follows 1-2 weeks after rash onset. [Harrisons, p. 447] See "Streptococcal Toxic-Shock Syndrome."
DIAGNOSTIC
Clinical; No specific diagnostic test; Positive blood cultures in <5%; Thrombocytopenia and abnormal liver & kidney function tests may be present; Paired sera for TSST-1 antibodies; [5MCC-2020]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • >fever, biphasic or relapsing
  • >myalgia
  • E pharyngitis
  • E stomatitis
  • G abdominal pain
  • G diarrhea
  • G liver function test, abnormal
  • G nausea, vomiting
  • H leukocytosis
  • H thrombocytopenia
  • N confusion, delirium
  • N lethargy
  • O conjunctivitis, acute
  • S rash (exanthem)
  • S rash on palms
  • *acute renal failure
  • *sepsis
  • *shock
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
RESERVOIR
Human
RISK FACTORS
DRUG LINK
MercK Manual: Toxic Shock Syndrome
REFERENCES FOR CASES/YEAR
1. (US) Published in MMWR 2011 = 78; Use correction factor of 10 for reported diseases: 78 X 10 = 780;
2. (Global) Calculate: 20 x 780 = 15,600;