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Staphylococcal Toxic Shock Syndrome
PY Mindmaps
Yung, A. et al (2004) “Infectious Disease: A Clinical Approach” Second Edition, IP
Communications Ltd
- staphylococcal toxin producing infection -> intoxication of exotoxins (TSS-1, 2 or 3
enterotoxin)-> toxic shock syndrome
- TSST acts as a superantigen activating T-cells directly and causing massive cytokine release
- rapid onset
- entry port for staphylococcus (tampon, swab, infected skin lesion, respiratory tract, post
partum, osteomyelitis)
- systemic symptoms (fever, chills, rigors)
- myalgias
- GI upset – vomiting and diarrhoea
- headache
- sore throat
- shock with multi-organ failure
generalised macular erythematous of skin with desquamation over time
non-purulent conjunctivitis
infected entry port
- blood cultures (are usually negative)
- routine bloods
- early recognition
- early and adequate antibiotic therapy
- source control
A – may be obtunded and require airway protection
B – ventilation to relieve work of breathing, may develop ALI/ARDS
Jeremy Fernando (2011)
C – large bore IV access, aggressive fluid resuscitation – often require alot, inotropic and
vasopressor support as tolerated, invasive monitoring
Specific Therapy
- remove source – remove tampon, debridement
- antibiotics - flucloxacillin 50mg/kg Q 6hrly or cephazolin 50mg/kg Q8 hrly
- clindamycin 25-40mg/kg/day in divided doses - controversial but believed to attenuate the
toxin production
- immunoglobulin IV 2g/kg LD -> 0.4g/kg for 5 days – mechanism uncertain ?binding of toxin
- hyperbaric oxygen – controversial and not always readily available
- low dose steroids – in refractory shock
General Therapy
Elevated creatinine and urea – fluid resuscitation
Hypoglycaemia - replacement
Low protein and albumin – supportive care
Elevated bilirubin and transaminases – supportive care
Metabolic acidosis – resuscitation
Jeremy Fernando (2011)