Toxic Shock Syndrome Follow-up
- Author: Ramesh Venkataraman, MBBS; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more...
Most patients who develop TSS are critically ill and should be transferred to an intensive care unit of an institution capable of caring for these patients.
Patients who recover from TSS are at risk of recurrent episodes of STSS. Consider or recommend preventive therapy (eg, discontinuation of tampon usage, administration of antistaphylococcal antibiotics) before and during each menstrual period for several months.
Chemoprophylaxis of household contacts of STSS patients: Household contacts of people with STSS have a higher risk of invasive GAS infection compared to the general population. The Centers for Disease Control and Prevention have not made definite recommendations; some authors have recommended a 10-day course of cephalosporin.
Severe complications from STTS include the following :
Prolonged and refractory hypovolemic shock (95%)
Adult respiratory distress syndrome (55%)
Acute renal failure (reversible in 70%, irreversible 10%)
Electrolyte and acid-base imbalance
Disseminated intravascular coagulation with thrombocytopenia
STSS carries a mortality rate of 3%, and streptococcal TSS has a mortality rate of 30%.
TSS may recur in patients who are not treated with beta-lactamase–resistant antimicrobial drugs.
Some patients with streptococcal TSS have respiratory symptoms and develop lobar consolidation and empyema. This condition may need to be distinguished from overwhelming Streptococcus pneumoniae sepsis.
Patient education about early signs and symptoms, risk factors and avoidance of tampon use may help prevent relapses. For excellent patient education resources, visit eMedicineHealth's Women's Health Center. Also, see eMedicineHealth's patient education article Toxic Shock Syndrome.
Todd J, Fishaut M, Kapral F. Toxic-shock syndrome associated with phage-group-I Staphylococci. Lancet. 1978 Nov 25. 2(8100):1116-8. [Medline].
Shands KN, Schmid GP, Dan BB. Toxic-shock syndrome in menstruating women: association with tampon use and Staphylococcus aureus and clinical features in 52 cases. N Engl J Med. 1980 Dec 18. 303(25):1436-42. [Medline].
Davis JP, Chesney PJ, Wand PJ. Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention. N Engl J Med. 1980 Dec 18. 303(25):1429-35. [Medline].
Ellies E, Vallée F, Mari A, Silva S, Bauriaud R, Fourcade O, et al. [Toxic shock syndrome consecutive to the presence of vaginal tampon for menstruation regressive after early haemodynamic optimization and activated protein C infusion]. Ann Fr Anesth Reanim. 2009 Jan. 28(1):91-5. [Medline].
Cone LA, Woodard DR, Schlievert PM. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med. 1987 Jul 16. 317(3):146-9. [Medline].
Stevens DL, Tanner MH, Winship J. Severe group A streptococcal infections associated with a toxic shock- like syndrome and scarlet fever toxin A. N Engl J Med. 1989 Jul 6. 321(1):1-7. [Medline].
Lappin E, Ferguson AJ. Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009 May. 9(5):281-90. [Medline].
Davies HD, McGeer A, Schwartz B. Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group. N Engl J Med. 1996 Aug 22. 335(8):547-54. [Medline].
Eriksson BK, Andersson J, Holm SE. Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome. Clin Infect Dis. 1998 Dec. 27(6):1428-36. [Medline].
Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis. 1992 Jan. 14(1):2-11. [Medline].
Demers B, Simor AE, Vellend H. Severe invasive group A streptococcal infections in Ontario, Canada: 1987-1991. Clin Infect Dis. 1993 Jun. 16(6):792-800; discussion 801-2. [Medline].
Matsuda Y, Kato H, Ono E, Kikuchi K, Muraoka M, Takagi K, et al. Diagnosis of toxic shock syndrome by two different systems; clinical criteria and monitoring of TSST-1-reactive T cells. Microbiol Immunol. 2008 Nov. 52(11):513-21. [Medline].
The Working Group on Severe Streptococcal Infections. Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. JAMA. 1993 Jan 20. 269(3):390-1. [Medline].
Park JS, Kim JS, Yi J, Kim EC. [Production and characterization of anti-staphylococcal toxic shock syndrome toxin-1 monoclonal antibody]. Korean J Lab Med. 2008 Dec. 28(6):449-56. [Medline].
Kalyan S, Chow AW. Staphylococcal toxic shock syndrome toxin-1 induces the translocation and secretion of high mobility group-1 protein from both activated T cells and monocytes. Mediators Inflamm. 2008. 2008:512196. [Medline].
Dixit S, Fischer G, Wittekind C. Recurrent menstrual toxic shock syndrome despite discontinuation of tampon use: Is menstrual toxic shock syndrome really caused by tampons?. Australas J Dermatol. 2012 Aug 17. [Medline].
Kaul R, McGeer A, Norrby-Teglund A. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group. Clin Infect Dis. 1999 Apr. 28(4):800-7. [Medline].
Stevens DL. The flesh-eating bacterium: what's next?. J Infect Dis. 1999 Mar. 179 Suppl 2:S366-74. [Medline].
Breshears LM, Schlievert PM, Peterson ML. A disintegrin and metalloproteinase 17 (ADAM17) and epidermal growth factor receptor (EGFR) signaling drive the epithelial response to Staphylococcus aureus toxic shock syndrome toxin-1 (TSST-1). J Biol Chem. 2012 Sep 21. 287(39):32578-87. [Medline]. [Full Text].
Norrby-Teglund A, Muller MP, Mcgeer A. Successful management of severe group A streptococcal soft tissue infections using an aggressive medical regimen including intravenous polyspecific immunoglobulin together with a conservative surgical approach. Scand J Infect Dis. 2005. 37(3):166-72. [Medline].
Rodríguez A, Rello J, Neira J, Maskin B, Ceraso D, Vasta L. Effects of high-dose of intravenous immunoglobulin and antibiotics on survival for severe sepsis undergoing surgery. Shock. 2005 Apr. 23(4):298-304. [Medline].
Karauzum H, Chen G, Abaandou L, et al. Synthetic human monoclonal antibodies toward staphylococcal enterotoxin B (SEB) protective against toxic shock syndrome. J Biol Chem. 2012 Jul 20. 287(30):25203-15. [Medline]. [Full Text].
[Guideline] Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014 Jul 15. 59(2):147-59. [Medline].
Barclay L. IDSA: skin and soft tissue infections guidelines updated. Medscape Medical News. Available at http://www.medscape.com/viewarticle/827399. Accessed: August 22, 2014.
[Guideline] Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013 Feb. 41(2):580-637. [Medline].