Toxic Shock Syndrome (TSS) is a severe, life-threatening condition characterized by the sudden onset of shock, multi-organ failure, and rash
Aetiology
TSS was historically associated with tampon use in menstruating women until manufacturers modified the absorbency levels
Currently, it is attributed to various infections
Primarily caused by Streptococcus (usually group A), Staphylococcus aureus and MRSA
Risk factors
Diabetes mellitus
Staphylococcal cellulitis
Wounds (especially burns)
Alcoholism and intravenous drug use
HIV
Tampon use or gynaecological infections (though less common now)
Pathophysiology
TSS is caused by the exotoxin produced by certain strains of bacteria, acting as a superantigen
This causes polyclonal T cell activation and massive cytokine release, notably IL-1 and TNF-alpha, leading to shock and multi-organ failure
Clinical features
Early non-specific flu-like symptoms, possibly accompanied by nausea, vomiting, and diarrhoea
Rapid progression to high fever and widespread macular rash, which often becomes erythrodermic, covering >90% of the body surface, including mucosal membranes
Multiorgan involvement, featuring hypotension due to cardiac depression and confusion from encephalopathy