Both types of TSS are mediated by exotoxins which activate the immune system to release inflammatory cytokines. These exotoxins act as superantigens, causing T cell activation and the resulting “cytokine storm” (TNF-alpha, interleukin [IL]-1, and IL-6) leads to profound shock and multi-organ failure.
Staphylococcal TSS produce Toxic-shock syndrome toxin-1 (TSST-1) and various enterotoxins whereas streptococcal TSS produces streptococcal pyrogenic exotoxins and virulence factors (M strains with M proteins 1 and 3).
