Toxic shock syndrome

Question 1

What is it

Answer 1

exotoxin-mediated multisystemic illness that is usually caused by Streptococcus (usually group A), Staphylococcus aureus and MRSA.

Question 2

Pathophysiology

Answer 2

TSST-1 superantigen toxin (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.

Question 3

CDC criteria

Answer 3

ever: temperature > 38.9ºC
hypotension: systolic blood pressure < 90 mmHg
diffuse erythematous rash
desquamation of rash, especially of the palms and soles
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

Question 4

Mx

Answer 4

removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics

Question 5

Invx

Answer 5

Sepsis Six
Throat swabs/ wound swabs or swabs taken from where the initial site of infection is believed to be.