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Toxic shock syndrome is a toxin-mediated, severe, life-threatening syndrome characterized by high fever, profound hypotension, diffuse erythroderma, mucous membrane hyperemia, pharyngitis, diarrhea, and constitutional symptoms. It can progress rapidly to multisystem dysfunction with severe electrolyte disturbances, renal failure, and shock. Toxic shock syndrome is associated with many risk factors, and most cases are no longer related to menses and tampon use.1 Streptococcal toxic shock syndrome, a similar but more menacing toxic shock syndrome–like disorder, has subsequently emerged in association with invasive and noninvasive streptococcal infections; see Streptococcal Toxic Shock Syndrome below.

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The case definition for toxic shock syndrome is provided in Table 145-1. In the absence of a definitive laboratory marker, the strict application of the case definition is warranted but undoubtedly excludes the less severe (subclinical) cases.2

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Table 145-1 Case Definition of Toxic Shock Syndrome
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Epidemiology

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Toxic shock syndrome initially emerged as a disease of young, healthy, menstruating women in the early 1980s; 50% of cases reported from 1979 to 1987 were found in this group. Tampon use increased the risk of toxic shock syndrome in susceptible females by 33 times. Changes in the composition of tampons (now composed ...

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