Toxic shock syndrome (TSS) is an acute, multisystem disease manifested by sudden onset of fever, chills, hypotension, and rash. It is caused by exotoxins released by Staphylococcus aureus and Streptococcus pyogenes. Multisystem involvement may cause vomiting, diarrhea, myalgia, mental confusion, renal dysfunction, hepatic abnormalities, and thrombocytopenia. The average incidence of TSS in Sweden is 1-2 per 100,000 individuals. The incidence of menstrual TSS has decreased since the discontinuation of hyperabsorbent tampons.
The treatment regimen for TSS includes administration of normal saline or colloids. Albumin replacement may be necessary in patients in whom albumin levels drop lower than 2 g/dL. Aggressive supportive care in an ICU is needed. Penicillin should be given in conjunction with clindamycin for antibiotic treatment. Clindamycin therapy for streptococcal TSS produces better results than penicillin. Studies demonstrate that both IV Immunoglobulins and clindamycin therapy contribute to a significantly improved survival in Streptococcal TSS. A study suggested that use of IV Immunoglobulins added to the cost of hospitalization but did not improve outcomes in streptococcal TSS.