Epidemiology:

It used to be associated with tampon use in menstruating women (until companies stopped making them super-absorbent), and is now known to be caused by a range of infections. Adults are usually more affected than children, and it is relatively rare with an overall prevalence of about 3/100000 people.

Pathogens

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

Pathophysiology

The 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.

Risk Factors

• Diabetes Mellitus
• Staphylococcal cellulitis
• Wounds (e.g. burns)
• Alcoholism and intravenous drug use
• HIV
• Tampon use (less common now) or gynaecological infections.

PC

• Initially non-specific flu-like symptoms, possibly with nausea, vomiting, and diarrhoea.
• There is then rapid progression to high fever and eruption of a widespread, macular rash. This usually becomes erythrodermic with >90% of the body surface involved, including mucosal membranes.
• Multiorgan involvement ensues, with hypotension due to cardiac depression and confusion due to encephalopathy.