++
++
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
++
++
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