Staphylococcal toxic shock syndrome (STSS) is a severe systemic illness caused by the release of superantigens by Staphylococcus aureus. The superantigens stimulate an overwhelming immune response. The diagnosis is clinical.
It peaks at 6 – 15 years and is more common in women.
- Pathophysiology
- Staphylococcus aureus produces superantigen exotoxins (toxic shock syndrome toxins) → polyclonal T-cells are activated → large amounts of pro-inflammatory cytokines are released → systemic inflammatory response syndrome (SIRS)
- Clonal deletion or anergy of specific T cell population → immunosuppression
- Signs and symptoms
- Fever
- Hypotensin
- Diffuse, blanching erythroderma
- Resembles sunburn
- Dequamation of the palms and soles occurs two weeks after onset
- Conjunctival injection
- Oral and vaginal mucosal hyperaemia
- Nauseaand vomiting
- Diarrhoea
- Myalgias
- Arthralgias
- Differentials
- Streptococcal toxic shock syndrome tends to have an erythematous and painful rash. It also has more prominent localised infection – cellulitis or necrotizing fasciitis
- Septic shock
- Kwasaki disease
- Investigations
- Blood culture
- Nasal swabs
- Tissue sample from suspected infection sites
- TSST-1 detection
- Serum creatinine and urea to assess renal function since acute kidney injury can occur
- Liver function tests for abnormalitie sin liver function
- CRP and complete blood count
- Blood gas analysis
- Echocardiography if endocarditis is suspected to be the source of bacteraemia
- Treatment
- Oxygen, if there is respiratory distress or hypoxia
- Fluid resuscitation
- Vasopressors if indicated
- Flucloxacillin + clindamycin (clindamycin suppresses toxin production while flucloxacillin targets the cell wall)
- Vancomycin/daptomycin + clindamycin if MRSA is suspected
- Debridement to control the source of infection
- Intravenous immunoglobulin (IVIG) for refractory cases
