Toxic Shock Syndrome - Signs and Symptoms

Signs and Symptoms

Symptoms of toxic shock syndrome vary depending on the underlying cause. TSS resulting from infection with the bacterium Staphylococcus aureus typically manifests in otherwise healthy individuals with high fever, accompanied by low blood pressure, malaise and confusion, which can rapidly progress to stupor, coma, and multiple organ failure. The characteristic rash, often seen early in the course of illness, resembles a sunburn, and can involve any region of the body, including the lips, mouth, eyes, palms and soles. In patients who survive the initial phase of the infection, the rash desquamates, or peels off, after 10–14 days.

In contrast, TSS caused by the bacterium Streptococcus pyogenes, or TSLS, typically presents in people with pre-existing skin infections with the bacteria. These individuals often experience severe pain at the site of the skin infection, followed by rapid progression of symptoms as described above for TSS. In contrast to TSS caused by Staphylococcus, streptococcal TSS less often involves a sunburn-like rash.

In either case, diagnosis is based strictly upon CDC criteria modified in 1981 after the initial surge in tampon-associated infections.:

1. Body temperature > 38.9 °C (102.02 °F)
2. Systolic blood pressure < 90 mmHg
3. Diffuse rash, intense erythroderma, blanching with subsequent desquamation, especially of the palms and soles
4. Involvement of three or more organ systems:
   • Gastrointestinal (vomiting, diarrhea)
   • Mucous membrane hyperemia (vaginal, oral, conjunctival)
   • Renal failure (serum creatinine > 2 times normal)
   • Hepatic inflammation (AST, ALT > 2 times normal)
   • Thrombocytopenia (platelet count < 100,000 / mm³)
   • CNS involvement (confusion without any focal neurological findings)