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.
