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==Overview== | ==Overview== | ||
[[Toxic shock syndrome]] ([[Toxic shock syndrome|TSS]]) is known to be caused due to intoxication by one of the various [[exotoxins]] produced by [[Staphylococcus aureus|''Staphylococcus aureus'']], namely toxic shock syndrome toxin-1 (TSST-1). It may also be caused by some strains of [[Group A streptococcal infection|''Group A streptococcal'']] (GAS) infection. <ref name="pmid24816557">{{cite journal |vauthors=Kulhankova K, King J, Salgado-Pabón W |title=Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression |journal=Immunol. Res. |volume=59 |issue=1-3 |pages=182–7 |year=2014 |pmid=24816557 |doi=10.1007/s12026-014-8538-8 |url=}}</ref> There have been reports of TSS caused by [[Clostridium perfringens|''Clostridium perfringens'']] and [[Clostridium sordellii|''Clostridium sordelli'']] in women undergoing medical abortion, [[parturition]] and gynaecological procedures.<sup>[[Toxic shock syndrome pathophysiology|[1][2][3][4][5]]]</sup> | [[Toxic shock syndrome]] ([[Toxic shock syndrome|TSS]]) is known to be caused due to intoxication by one of the various [[exotoxins]] produced by [[Staphylococcus aureus|''Staphylococcus aureus'']], namely toxic shock syndrome toxin-1 (TSST-1). It may also be caused by some strains of [[Group A streptococcal infection|''Group A streptococcal'']] (GAS) infection. <ref name="pmid24816557">{{cite journal |vauthors=Kulhankova K, King J, Salgado-Pabón W |title=Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression |journal=Immunol. Res. |volume=59 |issue=1-3 |pages=182–7 |year=2014 |pmid=24816557 |doi=10.1007/s12026-014-8538-8 |url=}}</ref> There have been reports of TSS caused by [[Clostridium perfringens|''Clostridium perfringens'']] and [[Clostridium sordellii|''Clostridium sordelli'']] in women undergoing medical abortion, [[parturition]] and gynaecological procedures.<sup>[[Toxic shock syndrome pathophysiology|[1][2][3][4][5]]]</sup> Some [[Virus|viruses]] have also been implicated in the development of [[toxic shock syndrome]]. | ||
== Causes == | == Causes == | ||
==== Common causes: ==== | ==== Common causes: ==== | ||
'''1.Staphylococcus associated Toxic shock syndrome (TSS)''' | |||
* ''[[Staphylococcus aureus]]'', a [[Gram-positive bacteria|gram positive]] [[coccus]] has been known to be a major cause of [[toxic shock syndrome]] via the production and intoxication by toxic shock syndrome toxin-1 (TSST-1). <ref name="pmid248165572">{{cite journal |vauthors=Kulhankova K, King J, Salgado-Pabón W |title=Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression |journal=Immunol. Res. |volume=59 |issue=1-3 |pages=182–7 |year=2014 |pmid=24816557 |doi=10.1007/s12026-014-8538-8 |url=}}</ref> | * ''[[Staphylococcus aureus]]'', a [[Gram-positive bacteria|gram positive]] [[coccus]] has been known to be a major cause of [[toxic shock syndrome]] via the production and intoxication by toxic shock syndrome toxin-1 (TSST-1). <ref name="pmid248165572">{{cite journal |vauthors=Kulhankova K, King J, Salgado-Pabón W |title=Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression |journal=Immunol. Res. |volume=59 |issue=1-3 |pages=182–7 |year=2014 |pmid=24816557 |doi=10.1007/s12026-014-8538-8 |url=}}</ref> | ||
**Staphylococcal enterotoxin F<ref name="pmid6112412">{{cite journal |vauthors=Bergdoll MS, Crass BA, Reiser RF, Robbins RN, Davis JP |title=A new staphylococcal enterotoxin, enterotoxin F, associated with toxic-shock-syndrome Staphylococcus aureus isolates |journal=Lancet |volume=1 |issue=8228 |pages=1017–21 |year=1981 |pmid=6112412 |doi= |url=}}</ref> | **Staphylococcal enterotoxin F<ref name="pmid6112412">{{cite journal |vauthors=Bergdoll MS, Crass BA, Reiser RF, Robbins RN, Davis JP |title=A new staphylococcal enterotoxin, enterotoxin F, associated with toxic-shock-syndrome Staphylococcus aureus isolates |journal=Lancet |volume=1 |issue=8228 |pages=1017–21 |year=1981 |pmid=6112412 |doi= |url=}}</ref> | ||
** ''[[Staphylococcus aureus|S. aureus]]'' colonizes the anterior nares and vagina of humans. About 20% of people are persistent carriers, 60% are intermittent carriers, and about 20% are almost never colonized by [[Staphylococcus aureus|''S. aureus'']]. <ref name="pmid9227864">{{cite journal |vauthors=Kluytmans J, van Belkum A, Verbrugh H |title=Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks |journal=Clin. Microbiol. Rev. |volume=10 |issue=3 |pages=505–20 |year=1997 |pmid=9227864 |pmc=172932 |doi= |url=}}</ref> | ** ''[[Staphylococcus aureus|S. aureus]]'' colonizes the anterior nares and vagina of humans. About 20% of people are persistent carriers, 60% are intermittent carriers, and about 20% are almost never colonized by [[Staphylococcus aureus|''S. aureus'']]. <ref name="pmid9227864">{{cite journal |vauthors=Kluytmans J, van Belkum A, Verbrugh H |title=Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks |journal=Clin. Microbiol. Rev. |volume=10 |issue=3 |pages=505–20 |year=1997 |pmid=9227864 |pmc=172932 |doi= |url=}}</ref> | ||
2.Group A streptococcus associated Toxic shock syndrome (Toxic sock-like syndrome, TSLS) | '''2.Group A streptococcus associated Toxic shock syndrome (Toxic sock-like syndrome, TSLS)''' | ||
* [[Streptococcus|Streptococcal]] TSS occurs most frequently in the setting of invasive infection due to group A ''Streptococcus'' (''[[Streptococcus pyogenes]]''). <ref name="pmid248165573">{{cite journal |vauthors=Kulhankova K, King J, Salgado-Pabón W |title=Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression |journal=Immunol. Res. |volume=59 |issue=1-3 |pages=182–7 |year=2014 |pmid=24816557 |doi=10.1007/s12026-014-8538-8 |url=}}</ref> | * [[Streptococcus|Streptococcal]] TSS occurs most frequently in the setting of invasive infection due to group A ''Streptococcus'' (''[[Streptococcus pyogenes]]''). <ref name="pmid248165573">{{cite journal |vauthors=Kulhankova K, King J, Salgado-Pabón W |title=Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression |journal=Immunol. Res. |volume=59 |issue=1-3 |pages=182–7 |year=2014 |pmid=24816557 |doi=10.1007/s12026-014-8538-8 |url=}}</ref> | ||
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==== Less common causes: ==== | ==== Less common causes: ==== | ||
'''1.Clostridium associated Toxic shock syndrome''' | |||
* ''[[Clostridium sordellii]]'' is a part of the normal flora of the vagina and may gain entry into the [[uterus]] via the [[cervix]] during spontaneous or induced [[abortion]], childbirth, or [[menstruation]]. ''C. sordellii'' is a cause of toxic shock syndrome associated with gynecologic procedures, parturition, and abortion (including spontaneous, surgical, and medical abortion). | * ''[[Clostridium sordellii]]'' is a part of the normal flora of the vagina and may gain entry into the [[uterus]] via the [[cervix]] during spontaneous or induced [[abortion]], childbirth, or [[menstruation]]. ''C. sordellii'' is a cause of toxic shock syndrome associated with gynecologic procedures, parturition, and abortion (including spontaneous, surgical, and medical abortion).<ref name="pmid2801850">{{cite journal |vauthors=McGregor JA, Soper DE, Lovell G, Todd JK |title=Maternal deaths associated with Clostridium sordellii infection |journal=Am. J. Obstet. Gynecol. |volume=161 |issue=4 |pages=987–95 |year=1989 |pmid=2801850 |doi= |url=}}</ref><ref name="pmid16049422">{{cite journal |vauthors= |title=Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol--United States and Canada, 2001-2005 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=54 |issue=29 |pages=724 |year=2005 |pmid=16049422 |doi= |url=}}</ref><ref name="pmid16319384">{{cite journal |vauthors=Fischer M, Bhatnagar J, Guarner J, Reagan S, Hacker JK, Van Meter SH, Poukens V, Whiteman DB, Iton A, Cheung M, Dassey DE, Shieh WJ, Zaki SR |title=Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion |journal=N. Engl. J. Med. |volume=353 |issue=22 |pages=2352–60 |year=2005 |pmid=16319384 |doi=10.1056/NEJMoa051620 |url=}}</ref><ref name="pmid12439811">{{cite journal |vauthors=Sinave C, Le Templier G, Blouin D, Léveillé F, Deland E |title=Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease |journal=Clin. Infect. Dis. |volume=35 |issue=11 |pages=1441–3 |year=2002 |pmid=12439811 |doi=10.1086/344464 |url=}}</ref><ref name="pmid19628200">{{cite journal |vauthors=Ho CS, Bhatnagar J, Cohen AL, Hacker JK, Zane SB, Reagan S, Fischer M, Shieh WJ, Guarner J, Ahmad S, Zaki SR, McDonald LC |title=Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age |journal=Am. J. Obstet. Gynecol. |volume=201 |issue=5 |pages=459.e1–7 |year=2009 |pmid=19628200 |doi=10.1016/j.ajog.2009.05.023 |url=}}</ref> | ||
'''2.Viral infection'''<ref name="pmid8353244">{{cite journal |vauthors=Tolan RW |title=Toxic shock syndrome complicating influenza A in a child: case report and review |journal=Clin. Infect. Dis. |volume=17 |issue=1 |pages=43–5 |year=1993 |pmid=8353244 |doi= |url=}}</ref> | |||
**[[Influenza virus]] | **[[Influenza virus]] | ||
**[[Varicella zoster virus]] | **[[Varicella zoster virus]] | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Syndromes]] | [[Category:Syndromes]] | ||
[[Category:Needs content]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Toxic shock syndrome (TSS) is known to be caused due to intoxication by one of the various exotoxins produced by Staphylococcus aureus, namely toxic shock syndrome toxin-1 (TSST-1). It may also be caused by some strains of Group A streptococcal (GAS) infection. [1] There have been reports of TSS caused by Clostridium perfringens and Clostridium sordelli in women undergoing medical abortion, parturition and gynaecological procedures.[1][2][3][4][5] Some viruses have also been implicated in the development of toxic shock syndrome.
Causes
Common causes:
1.Staphylococcus associated Toxic shock syndrome (TSS)
- Staphylococcus aureus, a gram positive coccus has been known to be a major cause of toxic shock syndrome via the production and intoxication by toxic shock syndrome toxin-1 (TSST-1). [2]
2.Group A streptococcus associated Toxic shock syndrome (Toxic sock-like syndrome, TSLS)
- Streptococcal TSS occurs most frequently in the setting of invasive infection due to group A Streptococcus (Streptococcus pyogenes). [5]
- Toxic shock syndrome has been seen as a complication in patients suffering from streptococcal pharyngitis and necrotizing fasciitis.[6]
- There have been reports of TSS in patients taking NSAIDs during infection by GAS. The possible mechanism that has been proposed, is inhibition of neutrophil function and increased cytokine production. [7]
Less common causes:
1.Clostridium associated Toxic shock syndrome
- Clostridium sordellii is a part of the normal flora of the vagina and may gain entry into the uterus via the cervix during spontaneous or induced abortion, childbirth, or menstruation. C. sordellii is a cause of toxic shock syndrome associated with gynecologic procedures, parturition, and abortion (including spontaneous, surgical, and medical abortion).[8][9][10][11][12]
2.Viral infection[13]
References
- ↑ Kulhankova K, King J, Salgado-Pabón W (2014). "Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression". Immunol. Res. 59 (1–3): 182–7. doi:10.1007/s12026-014-8538-8. PMID 24816557.
- ↑ Kulhankova K, King J, Salgado-Pabón W (2014). "Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression". Immunol. Res. 59 (1–3): 182–7. doi:10.1007/s12026-014-8538-8. PMID 24816557.
- ↑ Bergdoll MS, Crass BA, Reiser RF, Robbins RN, Davis JP (1981). "A new staphylococcal enterotoxin, enterotoxin F, associated with toxic-shock-syndrome Staphylococcus aureus isolates". Lancet. 1 (8228): 1017–21. PMID 6112412.
- ↑ Kluytmans J, van Belkum A, Verbrugh H (1997). "Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks". Clin. Microbiol. Rev. 10 (3): 505–20. PMC 172932. PMID 9227864.
- ↑ Kulhankova K, King J, Salgado-Pabón W (2014). "Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression". Immunol. Res. 59 (1–3): 182–7. doi:10.1007/s12026-014-8538-8. PMID 24816557.
- ↑ Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E (1989). "Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A". N. Engl. J. Med. 321 (1): 1–7. doi:10.1056/NEJM198907063210101. PMID 2659990.
- ↑ Stevens DL (1995). "Could nonsteroidal antiinflammatory drugs (NSAIDs) enhance the progression of bacterial infections to toxic shock syndrome?". Clin. Infect. Dis. 21 (4): 977–80. PMID 8645850.
- ↑ McGregor JA, Soper DE, Lovell G, Todd JK (1989). "Maternal deaths associated with Clostridium sordellii infection". Am. J. Obstet. Gynecol. 161 (4): 987–95. PMID 2801850.
- ↑ "Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol--United States and Canada, 2001-2005". MMWR Morb. Mortal. Wkly. Rep. 54 (29): 724. 2005. PMID 16049422.
- ↑ Fischer M, Bhatnagar J, Guarner J, Reagan S, Hacker JK, Van Meter SH, Poukens V, Whiteman DB, Iton A, Cheung M, Dassey DE, Shieh WJ, Zaki SR (2005). "Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion". N. Engl. J. Med. 353 (22): 2352–60. doi:10.1056/NEJMoa051620. PMID 16319384.
- ↑ Sinave C, Le Templier G, Blouin D, Léveillé F, Deland E (2002). "Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease". Clin. Infect. Dis. 35 (11): 1441–3. doi:10.1086/344464. PMID 12439811.
- ↑ Ho CS, Bhatnagar J, Cohen AL, Hacker JK, Zane SB, Reagan S, Fischer M, Shieh WJ, Guarner J, Ahmad S, Zaki SR, McDonald LC (2009). "Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age". Am. J. Obstet. Gynecol. 201 (5): 459.e1–7. doi:10.1016/j.ajog.2009.05.023. PMID 19628200.
- ↑ Tolan RW (1993). "Toxic shock syndrome complicating influenza A in a child: case report and review". Clin. Infect. Dis. 17 (1): 43–5. PMID 8353244.