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Key Features

  • Strains of staphylococci may produce toxins that can cause four important entities

    • Scalded skin syndrome, typically in children, or bullous impetigo in adults

    • Necrotizing pneumonitis in children

    • Toxic shock syndrome (TSS)

    • Enterotoxin food poisoning

  • Most cases (≥ 90%) of TSS were initially reported in women of childbearing age, especially common within 5 days of the onset of a menstrual period in women who have used tampons

  • Organisms from various sites, including the nasopharynx, bones, vagina, and rectum, or wounds have all been associated with the illness

Clinical Findings

  • Toxic shock is characterized by abrupt onset of fever, vomiting, and watery diarrhea

  • A diffuse macular erythematous rash and nonpurulent conjunctivitis are common, and desquamation, especially of the palms and soles, is typical during recovery

Diagnosis

  • Blood cultures classically are negative because symptoms are due to the effects of the toxin and not to the invasive properties of the organism

Treatment

  • Rapid rehydration, antistaphylococcal antibiotics (eg, parenteral nafcillin or oxacillin or, in the penicillin allergic patient, clindamycin), management of renal or cardiac failure, and most importantly removal of sources of toxin (eg, removal of tampon, drainage of abscess)

  • Intravenous clindamycin, 900 mg every 8 hours, is often added to inhibit toxin production

  • Intravenous immune globulin may be considered, although there are limited data compared to streptococcus toxic shock syndrome

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