Toxic shock syndrome natural history, complications and prognosis

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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

If left untreated toxic shock syndrome after initial presentation, may rapidly lead to multiorgan system failure with serious morbidity and mortality. Appropriate treatment leads to full recovery of the patient.

Natural History, Complications and Prognosis

During the early phase of development of Toxic shock syndrome (TSS), the patient will develop severe flu-like symptoms such as a high fever, vomiting, a sun-burn like rash, muscle aches and general weakness. If left untreated, these symptoms may progress to hypotension, tachycardia, high grade fever, diarrhoea, vomiting, irritability, drowsiness and eventually organ faliure. Early recognition and aggressive management can decrease the overall morbidity and mortality of toxic shock syndrome.

Complications

Toxic shock syndrome (TSS) may lead to the following complications:

• Severe organ dysfunction
  • Kidney failure
  • Heart failure
  • Liver failure
  • ARDS
• Shock
• Patients with initial soft tissue infection due to Group A Streptococci (GAS), presenting as toxic shock syndrome may deteriorate rapidly leading to necrotizing fasciitis and myositis, which may give rise to a compartment syndrome with associated rhabdomyolysis.

Prognosis

• Patients with Toxic shock syndrome who are diagnosed early and given appropriate treatment often have a good prognosis. Early treatment can help prevent complications such as renal failure, respiratory failure, and coagulation disorders. However, the mortality (death) rate is about 5%-15%, and patients who develop complications have a poorer prognosis than those who do not. Patients who develop TSS are at risk for reinfection

• Some of the factors which may lead to a poor outcome for a patient suffering from toxic shock syndrome are:
  • Leukocytopenia
  • Thrombocytopenia
  • Hypotension
  • Low temperature
  • High blood creatinine levels

References

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