Toxic shock syndrome
Toxic shock syndrome is a rapidly progressive toxin-mediated illness caused by Staphylococcus aureus or group A Streptococcus, with fever, diffuse rash, hypotension and multi-organ dysfunction; treat it as an emergency with sepsis resuscitation, immediate source control and specialist antimicrobial therapy.
Definition
Toxic shock syndrome is an acute toxin-mediated systemic illness caused by superantigen-producing Staphylococcus aureus or group A Streptococcus, characterised by fever, diffuse rash or erythema, hypotension and multi-organ dysfunction.
First principles
Superantigens trigger an exaggerated immune response
Staphylococcal TSST-1 and enterotoxins, and streptococcal pyrogenic exotoxins, can act as superantigens. They cross-link MHC class II and T-cell receptors outside the usual peptide-binding groove, activating many T cells at once and releasing cytokines out of proportion to the local infection.
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