Toxic shock syndrome

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  • 1-2/100,000 cases/year
  • S. aureus strain that produces toxic shock syndrome toxin-1 (superantigen) is the most common cause
    • GAS is a less common cause
  • Superantigens stimulate T-cell proliferation independent of antigen-specific binding → massive cytokine production
    • Also affect neutrophil chemotaxis suppression and blockage of reticuloendothelial system

Risk Factors

Clinical Features[1]

  • Fever: temperature >38.9°C
  • Rash: diffuse macular erythroderma
  • Hypotension: systolic blood pressure <90 mm Hg (adults) or <5th percentile for age (children younger than 16 years), or orthostatic hypotension, dizziness, or syncope
  • Multisystem dysfunction: at least 3:
    • Gastrointestinal: vomiting or diarrhea at onset of illness
    • Muscular: severe myalgias, or serum creatine phosphokinase level (CPK) greater than twice the upper limit of normal
    • Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
    • Renal: blood urea nitrogen or creatinine level greater than twice the upper limit of normal, or pyuria (5 leukocytes per high-power field), in the absence of urinary tract infection
    • Hepatic: total serum bilirubin or transaminase level greater than twice the upper limit of normal
    • Hematologic: platelets<100,000/L
    • Central nervous system: disorientation or alteration in consciousness but no focal neurologic signs at a time when fever and hypotension are absent.
  • Desquamation: One to 2 weeks after the onset of illness (typically palms and soles)

Differential Diagnosis

Erythematous rash


  • Lab Criteria for Diagnosis (if obtained)[1]:
  • Confirmed case meets all 5 clinical criteria (clinical features) plus lab criteria
  • Probable case meets 4-5 clinical criteria plus lab criteria



  • Admit


  1. 1.0 1.1 CDC. Toxic Shock Syndrome (Other Than Streptococcal). 2011