Toxic Shock Syndrome

 

• Pathophysiology

  • Shock triggered by superantigen exotoxins from Staph. aureus or Group A Strep.
  • Now more commonly due to spread from skin/soft tissue infection or tonsillitis. Previously from super-absorbent tampons.
  • Differs from septic shock in its pathophysiology – exotoxin-mediated – and management – which may involve IVIg in addition to antibiotics.

• Signs and symptoms

  Obs:

  • SBP <90
  • Temp ≥39°C

  Rash:

  • Blanching (e.g. with a handprint) macular erythrodermic rash including on palms and soles.
  • Desquamation 1-2 weeks later.
  • Strawberry tongue.

  Multiorgan failure:

  • Confusion
  • Diarrhoea and vomiting.
  • Liver and kidney failure.

• Investigations

  • FBC: WBC, ↓platelets.
  • U&E and LFTs for signs of organ dysfunction.
  • Cultures: blood, tissue. Blood culture often negative as disease is due to toxin, not bacteria.
  • Clotting may be deranged if there is associated DIC.

• Management

  • Clindamycin IV has anti-toxin effects.
  • IVIg if severe.