Clinical and Laboratory Manifestations of Toxic Shock Syndrome

Abstract

We studied 28 women and two men, with a median age of 20 years, who first had toxic shock syndrome between 1 February 1980 and 15 July 1981. Two of these patients died. All patients had intense myalgia, high fever (greater than or equal to 38.9 degrees C), hypotension or syncope, skin rash and desquamation, and abnormalities in at least three organ systems. Over half had sterile pyuria; immature granulocytic leukocytosis; coagulation abnormalities; hypocalcemia; low serum albumin and total protein concentrations; and elevations of blood urea nitrogen, alanine transaminase, bilirubin, and creatine kinase. Staphylococcus aureus was isolated from cultures from sites of soft-tissue infection in both male patients and from 13 of 19 vaginal and eight of 12 cervical cultures. All isolates produced both pyrogenic exotoxin C and enterotoxin F. All patients with a febrile, exanthematous, multisystem illness, particularly one associated with menstruation or a staphylococcal infection, should be promptly evaluated and empirically treated for toxic shock syndrome.

The effect of Mycoplasma arthritidis infection on the kinetics of colloidal carbon clearance in mice

“…The late expansion of the macrophage population might have implications for the development of autoimmunity involving the stimulation of autoreactive clones of T and B cells. Synovitis and arthritis occur frequently in patients with toxic shock syndrome induced by bacterial superantigens [23] and the present report indicates that the effects of mycoplasma on phagocytic activity and on the liver and spleen might contribute to the development of chronic arthritis in mice.…”

Recognition and management of Staphylococcus aureus toxin‐mediated disease

“…2,7,83,86 The same pathological process occurs at mucous membranes (particularly those colonized with the enterotoxinproducing S. aureus), resulting in conjunctival, oropharyngeal and vaginal hyperaemia and subsequent ulceration. 7,86 Histological examination of involved skin and mucous membranes demonstrates perivascular lymphocytic infiltration, superficial ulceration and occasionally dermal-epidermal cleavage which may resemble that seen with toxic epidermal necrolysis. 2,83,85 A fine erythematous maculopapular rash occurs later in the acute course in a significant proportion of survivors.…”

“…62,87 A characteristic manifestation of TSS is desquamation of skin of the hands and feet (including palms, soles, fingers and toes) which occurs 10-21 days after disease onset, and this is also described in other superantigenmediated disease states such as streptococcal toxic shock syndrome and Kawasaki's disease. 2,7,86 Telogen effluvium (which occurs as a result of disturbed metabolism and keratinization of the hair and nails resulting in hair loss and disordered nail growth) can occur after 4-16 weeks, with restoration of normal growth occurring 5-6 months following recovery. 7,86,88 Other conditions that may mimic TSS at some stage Internal Medicine Journal 2005; 35: S106-S119 Table 2 Centers for Disease Control (CDC) clinical case definition of toxic shock syndrome 81 1.…”

“…2,7,86 Telogen effluvium (which occurs as a result of disturbed metabolism and keratinization of the hair and nails resulting in hair loss and disordered nail growth) can occur after 4-16 weeks, with restoration of normal growth occurring 5-6 months following recovery. 7,86,88 Other conditions that may mimic TSS at some stage Internal Medicine Journal 2005; 35: S106-S119 Table 2 Centers for Disease Control (CDC) clinical case definition of toxic shock syndrome 81 1. Temperature ≥38.9°C 2.…”

Intensivmedizinische Besonderheiten beim toxischen Schocksyndrom ("toxic-shock-syndrome", TSS)

“…Die klinische Symptomatik des TSS wird durch die Diagnosekriterien der CDC Der Anaesthesist 9 · 2003 | 807 (⊡ Tabelle 2) charakterisiert und ist in der Initialphase typischerweise von raschem Temperaturanstieg und Hypotension bis hin zu schwersten therapierefraktären Blutdruckabfällen sowie durch ein feinfleckiges Exanthem und Hyperämie der Schleimhäute gekennzeichnet [7,18,30,46]. Weitere Symptome sind Erbrechen, Diarrhoen, Myalgien und Arthralgien, Öde-meinlagerungen,zentralnervöse Symptome, sowie Störungen der Nieren-, Lungen-, Leber-und Herz-Kreislauf-Funktion [18,30].Der weitere Krankheitsverlauf ist vom Ausmaß der Organschädigung durch die hypotensive Minderperfusion der Gewebe abhängig [9,30].…”