Toxic Shock Syndrome Flashcards
What is toxic shock syndrome?
Toxic Shock Syndrome is an exotoxin-mediated multisystemic illness that is usually caused by Streptococcus (usually group A), Staphylococcus aureus and MRSA.
Briefly describe the pathophysiology of toxic shock syndrome
The exotoxin acts as a superantigen, causing polyclonal T cell activation and massive cytokine release, particularly IL-1 and TNF-alpha. This can lead to shock and multi-organ failure.
What are the risk factors for toxic shock syndrome?
- Diabetes Mellitus
- Staphylococcal cellulitis
- Wounds (e.g. burns)
- Alcoholism and intravenous drug use
- HIV
- Tampon use (less common now) or gynaecological infections.
What are the clinical features of toxic shock syndrome?
Initially non-specific flu-like symptoms, possibly with nausea, vomiting, and diarrhoea.
There is then rapid progression to high fever and eruption of a widespread, macular rash. This usually becomes erythrodermic with >90% of the body surface involved, including mucosal membranes.
Multiorgan involvement ensues, with hypotension due to cardiac depression and confusion due to encephalopathy.
What investigations should be ordered for toxic shock syndrome?
- Sepsis Six
- Throat swabs and wound swabs or swabs taken from where the initial site of infection is believed to be
Briefly describe the management of toxic shock syndrome
DRABCDE approach with particular attention to aggressive fluid and electrolyte resuscitation. May need central venous pressure monitoring and vasopressors to manage the shock.
Persisting sources of infection need to be addressed immediately e.g. abscesses, infected wound, tampon.
Antibiotics depending on local guidelines but usually clindamycin + a cephalosporin/meropenem/vancomycin to allow broad spectrum cover.
Surgical debridement, drainage or amputation depending on the source.
Corticosteroids may be used as evidence that they increase survival.
