| • | hard to make a definitive bacterial diagnosis with staph toxic shock, therefore treat to cover both staph and strep |
TSS is the prototypical superantigen mediated disease:
menstrual vs. non-menstrual TSS:
| • | currently non-menstrual is more common (no super absorbent tampons on the market anymore) |
| • | most cases of non-menstrual occur in the post-op setting (catheter tip, nasal packing etc...) |
| • | but the classic signs of localized infection such as erythema, tenderness, and purulence may be absent from the site of infection, thereby making clinical diagnosis challenging |
| • | still, treatment must include draining infected sites |
| • | menstrual – TSST-1 (90%) |
| • | non-menstrual – TSST-1 (50%); otherwise SEB or SEC |
| • | clinically similar diseases: |
| • | fever, rash, desquamation, hypotension, and multiple organ involvement are the hallmarks |
| • | rash = “diffuse macular erythroderma” often with flexural accentuation |
| • | (erythema and edema of palms and soles, hyperemia of conjunctiva and mucous membranes, and strawberry tongue are often noted) |
Streptococcal TSS-like syndrome (STSS)
| • | toxin = SPE-A (most commonly) |
| • | also mediated by massive cytokine release (TNF-alpha and IL-1) |
| • | therefore similar clinical signs to TSS |
| • | difficult to distinguish STSS from TSS in some cases, therefore need adequate antimicrobial coverage (clindamycin, cephalosporins, erythromycin) |
differences (from TSS):
| • | skin is often the portal of entry in STSS, with soft tissue infections developing in 80% of patients (e.g. a bullous and hemorrhagic cellulitis, necrotizing fasciitis or myositis, and gangrene) |
| • | soft tissue involvement of this nature is distinctly uncommon in staphylococcal TSS |
| • | the initial clinical presentation of STSS is often a localized pain in an extremity which rapidly progresses over 48-72 hours |
| • | blood cultures positive in 50% of patient with STSS (15% in TSS) |
| • | mortality rates are 5X higher is STSS |
|