eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Toxic Shock Syndrome: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Contributor Information and Disclosures

Updated: Jan 27, 2009

Follow-up

Further Inpatient Care

  • Transfer patients with toxic shock syndrome (TSS) to the ICU for closer observation and aggressive therapy for hypotension and other complications.
  • Patients with acute respiratory distress syndrome (ARDS) may require ventilatory support.
  • Dialysis may be necessary in patients with severe renal failure.

Further Outpatient Care

  • Female patients with staphylococcal infection should be warned against the use of tampons.

Deterrence/Prevention

  • Antistaphylococcal therapy for staphylococcal toxic shock syndrome decreases recurrence.
  • Patients with staphylococcal toxic shock syndrome should avoid tampon use.
  • Use of other intravaginal devices should be avoided in patients with toxic shock syndrome.
  • Scrupulous wound care and appropriate early treatment of wounds should minimize toxic shock syndrome as a complication of these infections.

Complications

  • Complications of staphylococcal toxic shock syndrome include the following:
    • Renal failure
    • Gangrenous/cyanotic extremities
    • Neuropsychiatric manifestations, such as memory loss and lack of concentration
  • Complications of streptococcal toxic shock syndrome include the following:
    • Renal dysfunction progressing or persisting in all patients for 48-72 hours despite treatment (patients may require dialysis)
    • ARDS in 55% of patients
    • Death in 30% of patients
  • Rarely, other complications may be noted, such as myocardial failure and pulmonary edema.

Prognosis

  • Staphylococcal toxic shock syndrome
    • The vast majority of patients with staphylococcal toxic shock syndrome recover uneventfully. The mortality rate is 3.3%.
    • Staphylococcal toxic shock syndrome can recur, particularly in the absence of antistaphylococcal therapy and with continued use of tampons.
    • Neuropsychiatric manifestations, such as memory loss and lack of concentration, may persist in some patients.
  • Streptococcal toxic shock syndrome: Prognosis is worse than in staphylococcal toxic shock syndrome and the mortality rate is 30%.

Patient Education

  • Female patients with staphylococcal toxic shock syndrome should be warned against the use of tampons.
  • For excellent patient education resources, visit eMedicine's Women's Health Center. Also, see eMedicine's patient education article Toxic Shock Syndrome.

Miscellaneous

Medicolegal Pitfalls

  • Failure to promptly debride necrotic tissue in patients with necrotizing fasciitis and streptococcal toxic shock syndrome (TSS) may lead to poor outcome.
  • Staphylococcal toxic shock syndrome may recur in the absence of effective antistaphylococcal therapy.
  • Staphylococcal toxic shock syndrome may recur if female patients are not warned against the use of tampons.
  • Failure to diagnose a mild case may result in legal liability.
  • Failure to remove tampons or other implicated foreign materials in the body may cause legal liability.
 


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, acute respiratory distress syndrome, conjunctival hyperemia, cyanosis, endophthalmitis, erythroderma, hypotension, leptospirosis, measles, menses, menstruation, myocarditis, myositis, perihepatitis, peritoneal effusions, peritonitis, pleural effusions, Rocky Mountain spotted fever, soft tissue necrosis, staphylococcal infection, staphylococcal TSS, Staphylococcus aureus, S aureus, streptococcal infection, streptococcal TSS, Streptococcus pyogenes, S pyogenes, tampon use, TSS toxin-1, TSST-1, vaginal hyperemia

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Vinod K Dhawan, MD, FACP, FRCP(C) is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada
Disclosure: Pfizer Inc None None

Medical Editor

David Jaimovich, MD, Chief Medical Officer, Joint Commission International and Joint Commission Resources
David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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