eMedicine Specialties > Emergency Medicine > Infectious Diseases

Toxic Shock Syndrome: Follow-up

Author: Vicken Y Totten, MD, MS, FACEP, FAAFP, Assistant Professor, Case Western Reserve University School of Medicine; Director of Research, Department of Emergency Medicine, University Hospitals, Case Medical Center
Coauthor(s): Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Contributor Information and Disclosures

Updated: Aug 31, 2009

Follow-up

Further Inpatient Care

  • Admit the patient with toxic shock syndrome (TSS) to the ICU for further hemodynamic monitoring and/or ventilatory support.
  • Parenteral antibiotic therapy should be administered for 7 days, followed by 7 days of oral therapy.
  • Some patients may require dialysis.

Further Outpatient Care

  • Close follow-up is recommended, because some patients can have sequelae.
  • Patients with one episode of toxic shock syndrome are at higher risk than the general population for further episodes. A recurrence may occur in 40-50% of cases.

Complications

  • Reversible loss of hair and nails
  • Prolonged neuromuscular abnormalities
  • Late-onset rash
  • Gangrene and/or cyanotic extremities
  • Memory and/or concentration difficulties
  • Recurrence of TSS

Prognosis

  • The prognosis generally is poor for streptococcal TSS, with mortality rate as high as 70%.
  • Recurrences may occur in 40-50% of patients.
    • Most recurrences occur sooner than 2 months after the initial episode.
    • Recurrences generally are less severe than the initial episode, but deaths have been reported.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Lack of early surgical control of the infection
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Dane Salandy, MD†, and previous editor, Charles V Pollack, Jr, MD, to the development and writing of this article.



More on Toxic Shock Syndrome

Overview: Toxic Shock Syndrome
Differential Diagnoses & Workup: Toxic Shock Syndrome
Treatment & Medication: Toxic Shock Syndrome
Follow-up: Toxic Shock Syndrome
Multimedia: Toxic Shock Syndrome
References
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Further Reading

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Keywords

toxic shock syndrome, TSS, toxic shock, toxins, endotoxin, exotoxin,  toxin-1, TSST-1, Streptococcus pyogenes exotoxin A, SPEA, S pyogenes exotoxin B, SPEB, streptococcal TSS, staphylococcal TSS, streptococcal toxic shock syndrome, staphylococcal toxic shock syndrome, pyrogenic toxin superantigens, pyrogenic toxin super-antigens, menstrual toxic shock, non-menstrual toxic shock

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Contributor Information and Disclosures

Author

Vicken Y Totten, MD, MS, FACEP, FAAFP, Assistant Professor, Case Western Reserve University School of Medicine; Director of Research, Department of Emergency Medicine, University Hospitals, Case Medical Center
Vicken Y Totten, MD, MS, FACEP, FAAFP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine
Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark L Plaster, MD, JD, Executive Editor, Emergency Physicians Monthly
Mark L Plaster, MD, JD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: M L Plaster Publishing Co LLC Ownership interest Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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