Staphylococcal Toxic Shock Syndrome (TSS)
Overview
Staphylococcal TSS is a rapid, toxin‑mediated systemic illness caused by Staphylococcus aureus. It typically presents acutely (often within 48 hours) with high fever, a diffuse maculopapular rash that may progress to desquamation, hypotension and multisystem organ dysfunction.
Although classically linked to tampon use, at least half of cases are non‑menstrual (wounds, surgical sites, mucosal colonisation). The diagnosis is clinical and the condition requires immediate resuscitation, early antibiotics (including toxin‑suppressing therapy) and prompt source control (NICE NG51; RCEM sepsis toolkit).
Pathophysiology
TSS is caused by staphylococcal exotoxins (for example TSST‑1 and some enterotoxins) acting as superantigens. These toxins trigger widespread T‑cell activation and massive cytokine release, producing capillary leak, vasodilatation and multisystem failure. Toxin production may be local without bacteraemia, so blood cultures are often negative despite severe systemic illness.
Epidemiology and prognosis
- Rapid onset, usually evolving over hours to less than 48 hours.
- Blood cultures positive in only approximately 5% of cases; cultures from wound or mucosal sites are positive much more often (≈80-90%).
- Mortality is significant (around 6% reported).
- Major complications include refractory shock, respiratory failure, cardiomyopathy and coagulopathy.
Clinical features
Presentation is dominated by abrupt systemic toxicity and multisystem involvement.