Toxic shock syndrome (TSS) facts
What is toxic shock syndrome?
Toxic shock syndrome is a severe illness associated with group A Streptococcus (GAS or Streptococcus pyogenes); this bacterium produces a toxin termed TSS toxin-1 (TSST-1). TSS was first described in 1978 in children, but subsequent reports identified TSS outbreaks in women and were associated with tampon use. Although first thought to be additionally associated with menstruation, over the past years, less than half of TTS cases have been associated with menstruation. Although most cases of TTS occur in women, about 25% of nonmenstrual infections occur in men. TSS is also associated with Staphylococcus infections; some strains of these bacteria produce exotoxins very similar to TSST-1.
What causes toxic shock syndrome?
The cause of toxic shock syndrome (TSS) is one of several closely related exotoxins secreted by bacteria that are infecting the person. The toxins activate T cells of the immune system to produce chemicals known as cytokines that subsequently cause shock and tissue damage. Although there are several closely related exotoxins, about 80% of individuals with TSS have an illness caused by TSST-1 or a similar exotoxin. Other exotoxins such as those produced by enterococci A, C, D, E, and H cause most of the remaining 20% of infections.
M protein, a filamentous protein on the cell membrane of group A Streptococcus bacteria enhances the likelihood of the bacterial strain being more likely to cause disease. Bacterial strains that lack M protein are less lethal because M protein can protect bacteria from host immune defenses. In addition, M protein apparently enhances cell damage and inflammation caused by exotoxins.
What are risk factors for toxic shock syndrome?
Risk factors for TSS include a history of using superabsorbent tampons, surgical wounds, history of using a diaphragm or contraceptive sponge, having a localized infection deep in the skin, abortion, burns, and immunosuppression (for example, as seen with diabetes and chronic lung or heart disease or in elderly patients).
What are toxic shock syndrome symptoms and signs?
TSS symptoms and signs a resemble those found in other infections; however, the most common symptoms of TSS are as follows:
Skin shedding may occur on the palms and soles of the feet about one or two weeks after the initial infection begins.
Picture of skin loss in toxic shock syndrome (TSS); SOURCE: CDCSome clinicians classify TSS by stages -- others do not. However, early symptoms such as a high fever and a falling blood pressure may occur before later stages of organ damage appear. Early symptoms can be confused with those of other diseases, like norovirus or other viral and bacterial infections, especially in young women.
How do physicians diagnose toxic shock syndrome?
In general, after the history and physical, if the patient has low blood pressure and multiorgan involvement characterized by two of the above listed symptoms of organ dysfunction (renal, lung, liver, skin, or blood), the clinical diagnosis of TSS is made, according to CDC criteria. A confirmation of the diagnosis is done by isolation of bacteria from a normally sterile site; the bacteria should be identified as capable of producing exotoxin that either is, or functions like, TSST-1.
What is the treatment for toxic shock syndrome?
The treatment for TSS varies from patient to patient; however, the following treatments are fairly common. Patients with TSS usually will be treated with two or more of the following treatments:
What is the prognosis of toxic shock syndrome?
Patients with TSS who are diagnosed early and given appropriate treatment often have a good prognosis. Early treatment can help prevent complications such as renal failure, respiratory failure, and coagulation disorders. However, the mortality (death) rate is about 5%-15%, and patients who develop complications have a poorer prognosis than those who do not. Patients who develop TSS are at risk for reinfection.
What causes toxic shock syndrome?
The cause of toxic shock syndrome (TSS) is one of several closely related exotoxins secreted by bacteria that are infecting the person. The toxins activate T cells of the immune system to produce chemicals known as cytokines that subsequently cause shock and tissue damage. Although there are several closely related exotoxins, about 80% of individuals with TSS have an illness caused by TSST-1 or a similar exotoxin. Other exotoxins such as those produced by enterococci A, C, D, E, and H cause most of the remaining 20% of infections.
M protein, a filamentous protein on the cell membrane of group A Streptococcus bacteria enhances the likelihood of the bacterial strain being more likely to cause disease. Bacterial strains that lack M protein are less lethal because M protein can protect bacteria from host immune defenses. In addition, M protein apparently enhances cell damage and inflammation caused by exotoxins.
What are risk factors for toxic shock syndrome?
Risk factors for TSS include a history of using superabsorbent tampons, surgical wounds, history of using a diaphragm or contraceptive sponge, having a localized infection deep in the skin, abortion, burns, and immunosuppression (for example, as seen with diabetes and chronic lung or heart disease or in elderly patients).
What are toxic shock syndrome symptoms and signs?
TSS symptoms and signs a resemble those found in other infections; however, the most common symptoms of TSS are as follows:
Skin shedding may occur on the palms and soles of the feet about one or two weeks after the initial infection begins.
Picture of skin loss in toxic shock syndrome (TSS); SOURCE: CDCSome clinicians classify TSS by stages -- others do not. However, early symptoms such as a high fever and a falling blood pressure may occur before later stages of organ damage appear. Early symptoms can be confused with those of other diseases, like norovirus or other viral and bacterial infections, especially in young women.
How do physicians diagnose toxic shock syndrome?
In general, after the history and physical, if the patient has low blood pressure and multiorgan involvement characterized by two of the above listed symptoms of organ dysfunction (renal, lung, liver, skin, or blood), the clinical diagnosis of TSS is made, according to CDC criteria. A confirmation of the diagnosis is done by isolation of bacteria from a normally sterile site; the bacteria should be identified as capable of producing exotoxin that either is, or functions like, TSST-1.
What is the treatment for toxic shock syndrome?
The treatment for TSS varies from patient to patient; however, the following treatments are fairly common. Patients with TSS usually will be treated with two or more of the following treatments:
What is the prognosis of toxic shock syndrome?
Patients with TSS who are diagnosed early and given appropriate treatment often have a good prognosis. Early treatment can help prevent complications such as renal failure, respiratory failure, and coagulation disorders. However, the mortality (death) rate is about 5%-15%, and patients who develop complications have a poorer prognosis than those who do not. Patients who develop TSS are at risk for reinfection.
Source: http://www.rxlist.com
Source: http://www.rxlist.com
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