Toxic shock syndrome

Staphylococcal Infections: Beyond “Conventional” Sepsis

by Andrew Ferguson

Ferguson A. Anesth Analg 2011; 113: 1283.

Gram-positive Toxic Shock Syndromes: A Pathophysiological Review

by Andrew Ferguson

The Lancet Infectious Diseases,  Volume 9, Issue 5, Pages 281 - 290, May 2009 . doi:10.1016/S1473-3099(09)70066-0. Co-authored with Dr. E. Lappin

Toxic shock syndrome (TSS) is an acute, multi-system, toxin-mediated illness, often resulting in multi-organ failure.... more Toxic shock syndrome (TSS) is an acute, multi-system, toxin-mediated illness, often resulting in multi-organ failure. It represents the most fulminant expression of a spectrum of diseases caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus). The importance of Gram-positive organisms as pathogens is increasing, and TSS is likely to be underdiagnosed in patients with staphylococcal or group A streptococcal infection who present with shock. TSS results from the ability of bacterial toxins to act as superantigens, stimulating immune-cell expansion and rampant cytokine expression in a manner that bypasses normal MHC-restricted antigen processing. A repetitive cycle of cell stimulation and cytokine release results in a cytokine avalanche that causes tissue damage, disseminated intravascular coagulation, and organ dysfunction. Specific therapy focuses on early identification of the illness, source control, and administration on antimicrobial agents including drugs capable of suppressing toxin production (eg, clindamycin, linezolid). Intravenous immunoglobulin has the potential to neutralise superantigen and to mitigate subsequent tissue damage.

Staphylococcal Toxic Shock Syndrome: Mechanisms and Management

by Andrew Ferguson

Silversides J, Lappin E, Ferguson AJ. Staphylococcal Toxic Shock Syndrome. Curr Infect Dis Rep 2010;12:392-400.

Staphylococcal toxic shock syndrome is a rare complication of Staphylococcus aureus infection in which bacterial... more Staphylococcal toxic shock syndrome is a rare complication of Staphylococcus aureus infection in which bacterial toxins act as superantigens, activating very large numbers of T cells and generating an overwhelming immune-mediated cytokine avalanche that manifests clinically as fever, rash, shock, and rapidly progressive multiple organ failure, often in young, previously healthy patients. The syndrome can occur with any site of S. aureus infection, and so clinicians of all medical specialties should have a firm grasp of the presentation and management. In this article, we review the literature on the pathophysiology, clinical features, and treatment of this serious condition with emphasis on recent insights into pathophysiology and on information of relevance to the practicing clinician.