From the Research
Toxic shock syndrome (TSS) is diagnosed based on specific clinical and laboratory criteria, including fever, diffuse macular erythroderma, hypotension, and involvement of three or more organ systems, as outlined in the most recent literature review 1. The diagnosis of TSS requires a comprehensive approach, considering the patient's medical history, physical examination, and laboratory results. The criteria for diagnosis include:
- Fever (temperature ≥38.9°C or 102°F)
- Diffuse macular erythroderma (sunburn-like rash)
- Hypotension (systolic blood pressure ≤90 mmHg or orthostatic drop)
- Involvement of three or more organ systems, such as:
- Gastrointestinal (vomiting, diarrhea)
- Muscular (severe myalgia or elevated creatine phosphokinase)
- Mucous membrane (vaginal, oropharyngeal, or conjunctival hyperemia)
- Renal (elevated blood urea nitrogen or creatinine)
- Hepatic (elevated liver enzymes)
- Hematologic (thrombocytopenia)
- Central nervous system (disorientation without focal neurologic signs) Additionally, blood cultures and cerebrospinal fluid cultures should be negative for pathogens other than Staphylococcus aureus or Streptococcus pyogenes, as these are the primary causative organisms 2, 1, 3. TSS is a medical emergency requiring immediate hospitalization, fluid resuscitation, removal of any potential source (like tampons or wound packing), and appropriate antibiotic therapy, typically with clindamycin (600-900 mg IV every 8 hours) plus vancomycin (15-20 mg/kg IV every 8-12 hours) or a beta-lactam antibiotic 4, 5. The syndrome results from bacterial toxins that act as superantigens, triggering massive cytokine release and systemic inflammatory response 1. Early recognition and treatment are crucial to reduce morbidity and mortality associated with TSS 3.