Toxic Shock Syndrome

TSS is a syndrome of fever, rash, syncope, hypotension/shock, and multiorgan involvement, usually caused by one or more S. aureus toxins.

Common Symptoms

Macule; papulomacular rash; syncope; shock; somnolence; hematuria; azotemia; confusion; hypotension

Causes and Pathogenesis

(1) Etiology: The exact cause is unknown, but nearly all cases involve phage group I toxigenic S. aureus producing TSST-1 or related exotoxins. Bacteria have been found on mucosa (nasopharynx, vagina, trachea) or necrotic sites (empyema, abscesses) and in menstruating women's vaginas. Women with vaginal colonization using tampons are at highest risk; mechanical/chemical factors from tampons may increase exotoxin production, which enters the blood through damaged mucosa/uterus. The toxin is TSST-1 (formerly staphylococcal enterotoxin F or pyogenic exotoxin C); occasionally group A β-hemolytic streptococci cause TSS. (2) Pathogenesis: Nearly all cases involve S. aureus; isolates come from vagina/cervix/tampons or other foci; early patients may have symptomatic vaginitis. It also occurs after nasal packing and in renal/pulmonary/soft-tissue staphylococcal infections. Susceptibility relates to lack of protective antitoxin antibodies; cytokine activation plays a role.

Treatment

Drug therapy, supportive therapy

Preventive Measures

No definitive prevention besides eradicating S. aureus; advise women not to use tampons during menstruation. Suspected cases: immediate admission, remove tampons/diaphragms, replace fluids/electrolytes, take mucosal/blood cultures, start β-lactamase-resistant penicillin/cephalosporin. 1. Health education in high-risk settings. 2. Skin hygiene and exercise. 3. Treat itchy dermatoses; avoid scratching. 4. Do not share towels/basins; isolate patients; disinfect/burn dressings. 5. Avoid alcohol/spicy food during illness.

Department to Visit

It is recommended to visit the Emergency department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.