Toxic Shock Syndrome

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Presentation :

S. aureus– and S. pyogenes–associated exotoxins result in excessive cytokine production
Staphylococcal TSS is associated with tampon use, nasal packings, surgical wounds, skin ulcers, burns, catheters, and injection drug use.
Streptococcal TSS is associated with skin and soft tissue infection, particularly nec fascitis.

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Antibiotics for streptococcal TSS consist of penicillin plus clindamycin, the latter added to eradicate the high inoculum of bacteria present and to suppress toxin production
If methicillin-susceptible S. aureus is the cause, nafcillin or oxacillin and clindamycin are recommended;
For MRSA, vancomycin and clindamycin are recommended (for intolerance to vancomycin, daptomycin or ceftaroline may be used).
Linezolid can be used if clindamycin resistance is present.
Although the 2014 IDSA guidelines do not recommend routine adjunctive intravenous immune globulin use in TSS, some experts favor its administration in streptococcal TSS based on reported mortality benefits.

Bacteremia and mortality rates are higher with streptococcal than staphylococcal TSS