Staphylococcal toxic shock syndrome
Staphylococcal toxic shock syndrome is a multisystem, toxin-mediated illness caused by TSST-1-producing Staphylococcus aureus acting as a superantigen, classically linked to prolonged tampon use, nasal packing, or a focal staphylococcal infection, diagnosed by a clinical case definition of fever, hypotension, diffuse desquamating rash, and involvement of three or more organ systems, and treated with source control plus antistaphylococcal antibiotics including clindamycin.
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What this article covers
- Overview
A toxin-mediated, multisystem illness, not a primary bloodstream infection: staphylococcal toxic shock syndrome (TSS) results from systemic absorption of a superantigen exotoxin from a localized or…
- Epidemiology
A rare but well-described syndrome, historically linked to high-absorbency tampon use: incidence rose sharply with certain highly absorbent tampon products and fell after their withdrawal.
- Risk factors
Prolonged or continuous use of tampons, particularly high-absorbency products, during menstruation: the single most historically important risk factor and the basis for tampon-labeling changes.
- Pathophysiology
TSST-1 functions as a superantigen, bypassing normal, antigen-specific T-cell activation: rather than being processed and presented in the MHC class II peptide groove, the toxin binds directly to the…
- Clinical features
Abrupt onset of high fever, often with flu-like myalgias, vomiting, and diarrhea, is typically the earliest feature.
- Differential diagnosis
Streptococcal toxic shock syndrome: caused by group A streptococcus; discriminated by frequent bacteremia (unlike staphylococcal TSS), an antecedent necrotizing skin/soft tissue infection, and…
- Diagnosis
Staphylococcal TSS is a clinical diagnosis confirmed by a defined multisystem case definition, because no single laboratory test is diagnostic: it is confirmed when fever ≥38.9°C (102.0°F)…
- Management
First, remove the inciting focus immediately: remove any tampon or nasal packing, and incise and drain any abscess or other localized collection.
- Complications
Multiorgan failure, including acute kidney injury, hepatic injury, and cardiac dysfunction from prolonged distributive shock, is the immediate life-threatening complication.
- Prognosis
Overall mortality is 5% to 10%, well below streptococcal TSS, reflecting toxin-mediated rather than primarily bacteremic pathophysiology.
- Prevention
Avoid prolonged, continuous use of high-absorbency tampons during menstruation; use the lowest absorbency needed and alternate with sanitary pads when feasible.
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