Toxic Shock Syndrome, Staphylococcus aureus

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

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

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

Rapid rehydration, antistaphylococcal antibiotics (eg, parenteral nafcillin or oxacillin or, in the penicillin allergic patient, clindamycin), management of kidney or heart 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