Toxic Shock Syndrome


Image result for bacteria


  • Staph or strep endotoxin leading to a massive immune response and end-organ damage

Risk Factors

  • Tampon use ( mainly staph)
  • Post-operative wound infections
  • Soft tissue infections
  • Sinusitis

Clinical Manifestations

CDC Criteria 

  1. Fever of 102.0°F
  2. Hypotension ≤90 mmHg for adults or less than 5th percentile by age for children <16 years of age
  3. Diffuse macular erythroderma
  4. Desquamation of skin 1 to 2 weeks after onset of rash (especially palms and soles)
  5. Negative blood cultures for an alternative pathogen
  6. Multisystem involvement ( 3 or more of the following organ systems)
Gastrointestinal: Vomiting or diarrhea at onset of illness
Muscular: Severe myalgia or creatine phosphokinase elevation >2 times the upper limit of normal
Mucous membranes: Vaginal, oropharyngeal, or conjunctival hyperemia
Renal: Blood urea nitrogen or serum creatinine >2 times the upper limit of normal or pyuria (>5 white blood count/high power field) in the absence of urinary tract infection
Hepatic: Bilirubin or transaminases >2 times the upper limit of normal
Hematologic: Platelets <100,000/microL
Central nervous system: Disorientation or alterations in consciousness without focal neurologic signs in the absence of fever and hypotension

Note: Toxic shock should be suspected in patients with rash, fever, and hypotension even if some diagnostic criteria are not met.

Erythroderma Rash


  • Hemodynamic support
  • Source control ( post-operative wounds should be explored even if they do not appear to be infected)


Clindamycin 900mg IV or 25 mg/kg to 40 mg/kg in children every 8hrs in adults AND Vancomycin 15 to 20 mg/kg  or 40 mg/kg in children every 8 to 12 hrs.

Emergency Medicine FOAM

Toxic Shock Syndrome Management: A tale of two patients

Early suspicion of toxic shock syndrome