Case of the Month #33 Toxic Shock Syndrome

Published 12/08/2022

What is the epidemiology of Toxic Shock Syndrome (TSS)?

TSS is rare and may occur in previously fit and healthy adults. Antibodies to TSST-1 develop in 90% to 95% of the population by the fourth decade so Staphylococcal TSS is predominantly a disease of young adults. Once thought to be predominantly due to retained sanitary products, the majority of staphylococcal TSS is now thought to be caused by non-menstrual factors. 

Streptococcal TSS can occur in all age groups and occurs in about a third of patients with Group A Streptococcal infection. Outbreaks within the community have been reported hence it being a notifiable disease to public health authorities. 

Staphylococcal TSS: approximately 0.07 per 100,000 people per year. Streptococcal TSS: approximately 1 case per 100,000 people per year. 

Progression of the case 

The patient receives 4 litres of crystalloid fluid resuscitation in ED, with minimal improvement to her haemodynamic observations. She receives broad spectrum antibiotics. Her initial blood results are as follows:  

Hb 

97 g/L 

Na  

140 mmol/L 

Bilirubin 

16 µmol/L 

WCC 

21 x109/L 

K  

4.5 mmol/L 

ALT 

101 IU/L 

Platelets 

95 x109/L 

Urea 

15 mmol/L 

ALP 

135 IU/L 

INR 

1.3 

Creatinine 

180 µmol/L 

CK 

525 IU/L 

 

She is transferred to ICU and commenced on noradrenaline via central line. Linezolid is added to her antibiotic regime. The general surgical team are involved in assessing her.