Toxic syndromes

Abstract

Toxic shock syndrome (TSS) is an acute, multisystem, toxin–mediated illness, often resulting in multiorgan failure. It represents the most fulminant expression of a spectrum of disease caused by toxin–producing strains of Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus). TSS results from the ability of bacterial toxins to act as superantigens. Most S. aureus and S. pyogenes infections begin on the skin or mucosal surfaces from direct inflammatory or cytotoxic effects of exotoxins. Despite a mortality rate higher than that of meningococcal septicemia, TSS has not achieved the same level of awareness among health–care professionals, who will generally encounter very few recognized cases during their careers. TSS may present anywhere within the health–care system, from occupational health departments to specialist hospital units, and may progress with a rapidity that, once seen, is never forgotten. It is therefore essential that all health–care practitioners have a sound appreciation of the clinical features, diagnosis, pathophysiology, and treatment of TSS.