Persistent Neuropsychological Sequelae of Toxic Shock Syndrome

Rosene, Karen; Copass, Michael K.; Kastner, Laura; Nolan, Charles M.; Eschenbach, David A.

doi:10.7326/0003-4819-96-6-865

Cited by 66 publications

(19 citation statements)

References 12 publications

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“…Ely and coworkers [2] found that 18.5% of 275 mechanically ventilated patients had persistent coma, and of the remaining patients 81.7% developed delirium. Similar findings have been reported by other investigators [3-6]. The delirium tends to involve bizarre and terrifying nightmares, hallucinations, and paranoid delusions – often of the clinical staff trying to rape, murder, or otherwise harm the patient [7,8].…”

Section: Measuring Cognitive Impairment: Intensive Care Unit Deliriumsupporting

confidence: 83%

Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure

Misak

2009

Critical Care

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A growing consensus seems to be emerging that neurocognitive outcomes are poor for patients who have been critically ill with acute respiratory distress syndrome and multiple organ failure. However, intensive care unit delirium, post-traumatic stress disorder, and other outcomes must be considered as potentially confounding factors. Once the uncertainty around the causes of postmorbid cognitive functioning is acknowledged, there are practical implications for appropriate rehabilitative interventions and there are ethical implications for the kinds of appropriate disclosure to patients.

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Section: Measuring Cognitive Impairment: Intensive Care Unit Deliriumsupporting

confidence: 83%

Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure

Misak

2009

Critical Care

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“…In 1986, the overall case fatality rate was estimated to be 4%, with young women as the highest risk group (median age, 25 years) [9]. In the early 1980s long-term morbidity was observed in up to 90% of TSS cases, with 20% experiencing recurrent episodes, 50% having long-term memory loss and abnormal EEG findings, and 23% having recurrent syncope or cardiomyopathy [10]–[11]. Since 1986, there has not been population-based active surveillance to assess the incidence or disease burden of TSS.…”

Section: Introductionmentioning

confidence: 99%

Staphylococcal Toxic Shock Syndrome 2000–2006: Epidemiology, Clinical Features, and Molecular Characteristics

et al. 2011

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IntroductionCirculating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000–2003. The last population-based assessment of TSS was 1986.MethodsPopulation-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000–2006. Medical records of potential cases were reviewed for case criteria, antimicrobial susceptibility, risk factors, and outcome. Superantigen PCR testing and PFGE were performed on available isolates from probable and confirmed cases.ResultsOf 7,491 hospitalizations that received one of the ICD-9 study codes, 61 TSS cases (33 menstrual, 28 non-menstrual) were identified. The average annual incidence per 100,000 of all, menstrual, and non-menstrual TSS was 0.52 (95% CI, 0.32–0.77), 0.69 (0.39–1.16), and 0.32 (0.12–0.67), respectively. Women 13–24 years had the highest incidence at 1.41 (0.63–2.61). No increase in incidence was observed from 2000–2006. MRSA was isolated in 1 menstrual and 3 non-menstrual cases (7% of TSS cases); 1 isolate was USA400. The superantigen gene tst-1 was identified in 20 (80%) of isolates and was more common in menstrual compared to non-menstrual isolates (89% vs. 50%, p = 0.07). Superantigen genes sea, seb and sec were found more frequently among non-menstrual compared to menstrual isolates [100% vs 25% (p = 0.4), 60% vs 0% (p<0.01), and 25% vs 13% (p = 0.5), respectively].DiscussionTSS incidence remained stable across our surveillance period of 2000–2006 and compared to past population-based estimates in the 1980s. MRSA accounted for a small percentage of TSS cases. tst-1 continues to be the superantigen associated with the majority of menstrual cases. The CDC case definition identifies the most severe cases and has been consistently used but likely results in a substantial underestimation of the total TSS disease burden.

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“…Impaired mem ory and poorly sustained concentration have been described in patients who required only intravenous fluids to restore blood pressure (67). These findings lead to speculation that the TSS-associated toxin(s) may have a direct effect on nerve or muscle tissue.…”

Section: Outcomementioning

confidence: 95%

The Disease Spectrum, Epidemiology, and Etiology of Toxic-Shock Syndrome

Chesney¹,

Bergdoll²,

Davis³

et al. 1984

Annu. Rev. Microbiol.

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From this composite picture of the history and recent developments related to TSS, several points are clear. TSS is not a new disease, and TST-producing strains of S. aureus are not new. What is new is the recent dramatic increase of this disease in young women who use tampons during menses and who lack antibody to TST. What is also new is the recognition that the disease commonly recurs but only in menstrually associated cases. What remains to be determined are the precise role of tampons, the factors leading to toxin induction, and the mechanism of action of this potent toxin. In order to better determine what these factors and mechanism of action are, and to determine if the TST marker protein is in fact the critical toxin, a reliable animal model is badly needed. Finally, a reliable laboratory test to confirm the clinical diagnosis is another high-priority need. The further unraveling of the secrets of this complex disease may greatly enhance our understanding of the disease associated with this toxin, of the intricacies of toxin production by other bacteria, and of the role that exogenous cofactors play in disease processes.

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Persistent Neuropsychological Sequelae of Toxic Shock Syndrome

Cited by 66 publications

References 12 publications

Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure

Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure

Staphylococcal Toxic Shock Syndrome 2000–2006: Epidemiology, Clinical Features, and Molecular Characteristics

The Disease Spectrum, Epidemiology, and Etiology of Toxic-Shock Syndrome

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