A review published in The Journal of Emergency Medicine provides a summary of the current evaluation and management of toxic shock syndrome (TSS), a severe, toxin-mediated illness that can present similarly to other diseases. If TSS is not detected and treated appropriately, it can potentially be fatal. 

According to the review, TSS is most commonly associated with Staphylococcus aureus and Streptococcus pyogenes, with sources of nonmenstrual staphylococcal TSS stemming from post-surgical wounds, burns, soft tissue injuries, pharyngitis, intrauterine device placement, and focal infections; streptococcal TSS occurs more commonly after viral infections and local soft tissue trauma. Symptoms, which arise from the production of toxins and infection focus, can include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension; later in the course of the disease, diffuse erythema and desquamation are possible. 

Laboratory testing may indicate anemia, thrombocytopenia, elevated liver enzymes, and prolonged coagulation tests. Although the Centers for Disease Control and Prevention (CDC) provides criteria for the diagnosis of TSS, “they should not be relied on for definitive diagnoses,” cautioned lead author Michael Gottlieb, MD. “Rather, specific situations should trigger consideration of this disease process.” 

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With regard to treatment, intravenous (IV) fluids, antibiotics, and source control are recommended. Treatment should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in areas where methicillin-resistant S. aureus is prevalent) in addition to clindamycin or linezolid. 

“Focused history, physical examination, and laboratory testing are important for the diagnosis and management of
this disease,” the authors conclude.

For more information visit jem-journal.com.